- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $331.13 / $457.09 / $457.09
| Facility | | $331.13 | $457.09 | $457.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,089.30 / $11,481.54 / $26,915.35
| Facility | | $2,089.30 | $11,481.54 | $26,915.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,096.48 / $1,737.80 / $4,168.69
| Facility | | $1,096.48 | $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
- $338.84 / $588.84 / $1,318.26
| Facility | | $338.84 | $588.84 | $1,318.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $3,548.13 / $9,332.54
| Facility | | $1,000.00 | $3,548.13 | $9,332.54 |