- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $403.29 / $403.29 / $3,052.87
| Facility | | $403.29 | $403.29 | $3,052.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,620.63 / $5,518.80 / $11,503.06
| Facility | | $1,620.63 | $5,518.80 | $11,503.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $981.57 / $1,392.71 / $3,350.36
| Facility | | $981.57 | $1,392.71 | $3,350.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $892.34 / $1,273.27 / $2,638.08
| Facility | | $892.34 | $1,273.27 | $2,638.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $403.29 / $688.82 / $4,746.00
| Facility | | $403.29 | $688.82 | $4,746.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,412.00 / $4,746.00 / $8,812.00
| Facility | | $2,412.00 | $4,746.00 | $8,812.00 |