- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,023.29 / $1,995.26 / $2,951.21
| Facility | | $1,023.29 | $1,995.26 | $2,951.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,318.26 / $1,949.84 / $3,388.44
| Facility | | $1,318.26 | $1,949.84 | $3,388.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,412.54 / $2,187.76 / $3,981.07
| Facility | | $1,412.54 | $2,187.76 | $3,981.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,148.15 / $1,148.15 / $1,445.44
| Facility | | $1,148.15 | $1,148.15 | $1,445.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $954.99 / $1,479.11 / $21,877.62
| Facility | | $954.99 | $1,479.11 | $21,877.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $229.09 / $616.60 / $1,202.26
| Facility | | $229.09 | $616.60 | $1,202.26 |