- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,611.50 / $2,611.50 / $4,908.68
| Facility | | $2,611.50 | $2,611.50 | $4,908.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $570.51 / $635.05 / $691.92
| Facility | | $570.51 | $635.05 | $691.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $612.28 / $612.28 / $612.28
| Facility | | $612.28 | $612.28 | $612.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,342.28 / $14,342.28 / $14,342.28
| Facility | | $14,342.28 | $14,342.28 | $14,342.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,096.79 / $9,096.79 / $9,096.79
| Facility | | $9,096.79 | $9,096.79 | $9,096.79 |