- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $363.05 / $363.05 / $363.05
| Facility | | $363.05 | $363.05 | $363.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,807.92 / $5,014.17 / $11,224.34
| Facility | | $1,807.92 | $5,014.17 | $11,224.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $802.68 / $1,138.30 / $2,738.33
| Facility | | $802.68 | $1,138.30 | $2,738.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $652.52 / $1,040.68 / $2,156.16
| Facility | | $652.52 | $1,040.68 | $2,156.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $571.24 / $663.88 / $3,500.00
| Facility | | $571.24 | $663.88 | $3,500.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,751.00 / $3,500.00 / $8,152.00
| Facility | | $1,751.00 | $3,500.00 | $8,152.00 |