- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $309.03 / $2,818.38 / $5,128.61
| Facility | | $309.03 | $2,818.38 | $5,128.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $630.96 / $1,659.59 / $28,840.32
| Facility | | $630.96 | $1,659.59 | $28,840.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $323.59 / $323.59 / $741.31
| Facility | | $323.59 | $323.59 | $741.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $275.42 / $588.84 / $7,079.46
| Facility | | $275.42 | $588.84 | $7,079.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $630.96 / $2,041.74 / $3,467.37
| Facility | | $630.96 | $2,041.74 | $3,467.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $645.65 / $1,659.59 / $28,840.32
| Facility | | $645.65 | $1,659.59 | $28,840.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $630.96 / $1,862.09 / $2,818.38
| Facility | | $630.96 | $1,862.09 | $2,818.38 |