- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,122.02 / $5,754.40 / $10,964.78
| Facility | | $1,122.02 | $5,754.40 | $10,964.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $954.99 / $3,388.44 / $16,982.44
| Facility | | $954.99 | $3,388.44 | $16,982.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $537.03 / $616.60 / $3,630.78
| Facility | | $537.03 | $616.60 | $3,630.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $562.34 / $954.99 / $4,466.84
| Facility | | $562.34 | $954.99 | $4,466.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $575.44 / $954.99 / $5,888.44
| Facility | | $575.44 | $954.99 | $5,888.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $100.00 / $100.00 / $7,244.36
| Facility | | $100.00 | $100.00 | $7,244.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $794.33 / $4,168.69 / $7,413.10
| Facility | | $794.33 | $4,168.69 | $7,413.10 |