- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,348.96 / $3,630.78 / $8,128.31
| Facility | | $1,348.96 | $3,630.78 | $8,128.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,737.80 / $1,819.70 / $1,819.70
| Facility | | $1,737.80 | $1,819.70 | $1,819.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $331.13 / $331.13 / $331.13
| Facility | | $331.13 | $331.13 | $331.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $758.58 / $1,202.26 / $6,918.31
| Facility | | $758.58 | $1,202.26 | $6,918.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,862.09 / $2,818.38 / $6,309.57
| Facility | | $1,862.09 | $2,818.38 | $6,309.57 |