- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $128.82 / $389.05 / $389.05
| Facility | | $128.82 | $389.05 | $389.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $851.14 / $3,630.78 / $8,709.64
| Facility | | $851.14 | $3,630.78 | $8,709.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $912.01 / $1,479.11 / $3,548.13
| Facility | | $912.01 | $1,479.11 | $3,548.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,122.02 / $1,412.54 / $2,754.23
| Facility | | $1,122.02 | $1,412.54 | $2,754.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $151.36 / $389.05 / $1,148.15
| Facility | | $151.36 | $389.05 | $1,148.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,445.44 / $3,467.37 / $6,456.54
| Facility | | $1,445.44 | $3,467.37 | $6,456.54 |