- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,148.15 / $1,698.24 / $2,089.30
| Facility | | $1,148.15 | $1,698.24 | $2,089.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,248.07 / $8,912.51 / $14,454.40
| Facility | | $5,248.07 | $8,912.51 | $14,454.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $776.25 / $1,148.15 / $2,570.40
| Facility | | $776.25 | $1,148.15 | $2,570.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $870.96 / $870.96 / $870.96
| Facility | | $870.96 | $870.96 | $870.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $776.25 / $1,148.15 / $2,570.40
| Facility | | $776.25 | $1,148.15 | $2,570.40 |