- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $426.58 / $478.63 / $478.63
| Facility | | $426.58 | $478.63 | $478.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,548.82 / $3,801.89 / $8,128.31
| Facility | | $1,548.82 | $3,801.89 | $8,128.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,230.27 / $1,737.80 / $4,168.69
| Facility | | $1,230.27 | $1,737.80 | $4,168.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,348.96 / $1,659.59 / $3,311.31
| Facility | | $1,348.96 | $1,659.59 | $3,311.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $426.58 / $741.31 / $1,348.96
| Facility | | $426.58 | $741.31 | $1,348.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $602.56 / $1,862.09 / $4,168.69
| Facility | | $602.56 | $1,862.09 | $4,168.69 |