- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,096.48 / $4,570.88 / $8,511.38
| Facility | | $1,096.48 | $4,570.88 | $8,511.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,630.78 / $4,365.16 / $10,964.78
| Facility | | $3,630.78 | $4,365.16 | $10,964.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $758.58 / $2,187.76 / $3,548.13
| Facility | | $758.58 | $2,187.76 | $3,548.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $562.34 / $562.34 / $562.34
| Facility | | $562.34 | $562.34 | $562.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $831.76 / $6,760.83 / $10,000.00
| Facility | | $831.76 | $6,760.83 | $10,000.00 |