- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $251.19 / $426.58 / $426.58
| Facility | | $251.19 | $426.58 | $426.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $602.56 / $5,495.41 / $13,182.57
| Facility | | $602.56 | $5,495.41 | $13,182.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,096.48 / $1,584.89 / $3,801.89
| Facility | | $1,096.48 | $1,584.89 | $3,801.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,230.27 / $1,513.56 / $3,019.95
| Facility | | $1,230.27 | $1,513.56 | $3,019.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $275.42 / $524.81 / $4,786.30
| Facility | | $275.42 | $524.81 | $4,786.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,884.03 / $5,248.07 / $8,912.51
| Facility | | $2,884.03 | $5,248.07 | $8,912.51 |