- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,290.87 / $5,754.40 / $12,589.25
| Facility | | $2,290.87 | $5,754.40 | $12,589.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,511.38 / $8,912.51 / $8,912.51
| Facility | | $8,511.38 | $8,912.51 | $8,912.51 |
- 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
- $1,348.96 / $2,041.74 / $5,011.87
| Facility | | $1,348.96 | $2,041.74 | $5,011.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,548.82 / $3,630.78 / $5,623.41
| Facility | | $1,548.82 | $3,630.78 | $5,623.41 |