- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,445.44 / $2,511.89 / $3,801.89
| Facility | | $1,445.44 | $2,511.89 | $3,801.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $426.58 / $758.58 / $1,778.28
| Facility | | $426.58 | $758.58 | $1,778.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $724.44 / $1,230.27 / $2,630.27
| Facility | | $724.44 | $1,230.27 | $2,630.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $724.44 / $977.24 / $3,981.07
| Facility | | $724.44 | $977.24 | $3,981.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12.88 / $426.58 / $17,378.01
| Facility | | $12.88 | $426.58 | $17,378.01 |