- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,202.26 / $3,890.45 / $8,511.38
| Facility | | $1,202.26 | $3,890.45 | $8,511.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,041.74 / $8,912.51 / $9,332.54
| Facility | | $2,041.74 | $8,912.51 | $9,332.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $630.96 / $630.96 / $630.96
| Facility | | $630.96 | $630.96 | $630.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $630.96 / $1,047.13 / $3,630.78
| Facility | | $630.96 | $1,047.13 | $3,630.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,548.82 / $2,570.40 / $4,677.35
| Facility | | $1,548.82 | $2,570.40 | $4,677.35 |