- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,096.48 / $3,388.44 / $7,762.47
| Facility | | $1,096.48 | $3,388.44 | $7,762.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,466.84 / $7,762.47 / $12,022.64
| Facility | | $4,466.84 | $7,762.47 | $12,022.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $39.81 / $1,584.89 / $2,818.38
| Facility | | $39.81 | $1,584.89 | $2,818.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $724.44 / $1,819.70 / $4,265.80
| Facility | | $724.44 | $1,819.70 | $4,265.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,096.48 / $4,677.35 / $11,748.98
| Facility | | $1,096.48 | $4,677.35 | $11,748.98 |