- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,584.89 / $1,584.89 / $1,584.89
| Facility | | $1,584.89 | $1,584.89 | $1,584.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $416.87 / $501.19 / $602.56
| Facility | | $416.87 | $501.19 | $602.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,905.46 / $2,137.96 / $4,073.80
| Facility | | $1,905.46 | $2,137.96 | $4,073.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $562.34 / $1,096.48 / $2,511.89
| Facility | | $562.34 | $1,096.48 | $2,511.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $125.89 / $1,819.70 / $2,951.21
| Facility | | $125.89 | $1,819.70 | $2,951.21 |