- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,899.76 / $1,899.76 / $8,763.29
| Facility | | $1,899.76 | $1,899.76 | $8,763.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,703.05 / $8,392.32 / $13,362.65
| Facility | | $2,703.05 | $8,392.32 | $13,362.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $546.08 / $546.08 / $1,656.16
| Facility | | $546.08 | $546.08 | $1,656.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $411.96 / $535.36 / $740.72
| Facility | | $411.96 | $535.36 | $740.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $936.00 / $6,599.00 / $7,158.00
| Facility | | $936.00 | $6,599.00 | $7,158.00 |