- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,659.59 / $2,818.38 / $5,888.44
| Facility | | $1,659.59 | $2,818.38 | $5,888.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,754.23 / $2,754.23 / $2,754.23
| Facility | | $2,754.23 | $2,754.23 | $2,754.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $741.31 / $831.76 / $1,047.13
| Facility | | $741.31 | $831.76 | $1,047.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $537.03 / $724.44 / $758.58
| Facility | | $537.03 | $724.44 | $758.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,659.59 / $2,818.38 / $5,888.44
| Facility | | $1,659.59 | $2,818.38 | $5,888.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,041.74 / $10,232.93 / $18,197.01
| Facility | | $2,041.74 | $10,232.93 | $18,197.01 |