- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,548.82 / $4,265.80 / $8,511.38
| Facility | | $1,548.82 | $4,265.80 | $8,511.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,238.72 / $4,677.35 / $8,912.51
| Facility | | $2,238.72 | $4,677.35 | $8,912.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $724.44 / $724.44 / $1,348.96
| Facility | | $724.44 | $724.44 | $1,348.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,202.26 / $2,818.38 / $26,302.68
| Facility | | $1,202.26 | $2,818.38 | $26,302.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,698.24 / $2,398.83 / $4,677.35
| Facility | | $1,698.24 | $2,398.83 | $4,677.35 |