- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $208.93 / $338.84 / $338.84
| Facility | | $208.93 | $338.84 | $338.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $489.78 / $7,079.46 / $16,595.87
| Facility | | $489.78 | $7,079.46 | $16,595.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $912.01 / $1,288.25 / $3,019.95
| Facility | | $912.01 | $1,288.25 | $3,019.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $977.24 / $1,230.27 / $2,398.83
| Facility | | $977.24 | $1,230.27 | $2,398.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $245.47 / $467.74 / $3,981.07
| Facility | | $245.47 | $467.74 | $3,981.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,019.95 / $6,025.60 / $10,715.19
| Facility | | $3,019.95 | $6,025.60 | $10,715.19 |