- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $549.54 / $549.54 / $549.54
| Facility | | $549.54 | $549.54 | $549.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,168.69 / $7,413.10 / $22,387.21
| Facility | | $4,168.69 | $7,413.10 | $22,387.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,288.25 / $1,819.70 / $4,365.16
| Facility | | $1,288.25 | $1,819.70 | $4,365.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,412.54 / $1,737.80 / $3,467.37
| Facility | | $1,412.54 | $1,737.80 | $3,467.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $562.34 / $1,148.15 / $5,754.40
| Facility | | $562.34 | $1,148.15 | $5,754.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,137.96 / $3,311.31 / $7,943.28
| Facility | | $2,137.96 | $3,311.31 | $7,943.28 |