- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,122.02 / $5,888.44 / $10,964.78
| Facility | | $1,122.02 | $5,888.44 | $10,964.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,698.24 / $3,388.44 / $15,135.61
| Facility | | $1,698.24 | $3,388.44 | $15,135.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $724.44 / $724.44 / $851.14
| Facility | | $724.44 | $724.44 | $851.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $724.44 / $1,174.90 / $21,379.62
| Facility | | $724.44 | $1,174.90 | $21,379.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $21,379.62 / $21,379.62 / $21,379.62
| Facility | | $21,379.62 | $21,379.62 | $21,379.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $100.00 / $100.00 / $3,548.13
| Facility | | $100.00 | $100.00 | $3,548.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,778.28 / $2,691.53 / $5,248.07
| Facility | | $1,778.28 | $2,691.53 | $5,248.07 |