- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,445.44 / $5,754.40 / $10,964.78
| Facility | | $1,445.44 | $5,754.40 | $10,964.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $954.99 / $3,019.95 / $7,943.28
| Facility | | $954.99 | $3,019.95 | $7,943.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $707.95 / $794.33 / $1,737.80
| Facility | | $707.95 | $794.33 | $1,737.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $575.44 / $1,258.93 / $2,818.38
| Facility | | $575.44 | $1,258.93 | $2,818.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $575.44 / $1,258.93 / $2,818.38
| Facility | | $575.44 | $1,258.93 | $2,818.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $100.00 / $100.00 / $3,388.44
| Facility | | $100.00 | $100.00 | $3,388.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $933.25 / $5,128.61 / $7,943.28
| Facility | | $933.25 | $5,128.61 | $7,943.28 |