- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,122.02 / $1,862.09 / $3,715.35
| Facility | | $1,122.02 | $1,862.09 | $3,715.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $194.98 / $194.98 / $223.87
| Facility | | $194.98 | $194.98 | $223.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $302.00 / $1,318.26 / $1,905.46
| Facility | | $302.00 | $1,318.26 | $1,905.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $54.95 / $77.62 / $162.18
| Facility | | $54.95 | $77.62 | $162.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $151.36 / $1,000.00 / $1,288.25
| Facility | | $151.36 | $1,000.00 | $1,288.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $208.93 / $208.93 / $208.93
| Facility | | $208.93 | $208.93 | $208.93 |