- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,288.25 / $2,630.27 / $12,589.25
| Facility | | $1,288.25 | $2,630.27 | $12,589.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,630.27 / $6,760.83 / $21,379.62
| Facility | | $2,630.27 | $6,760.83 | $21,379.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $933.25 / $1,288.25 / $1,659.59
| Facility | | $933.25 | $1,288.25 | $1,659.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,737.80 / $1,737.80 / $1,862.09
| Facility | | $1,737.80 | $1,737.80 | $1,862.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $977.24 / $5,011.87 / $12,302.69
| Facility | | $977.24 | $5,011.87 | $12,302.69 |