- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $129.05 / $386.97 / $2,042.00
| Facility | | $129.05 | $386.97 | $2,042.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $674.82 / $3,084.88 / $6,762.24
| Facility | | $674.82 | $3,084.88 | $6,762.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $895.40 / $1,397.49 / $3,361.85
| Facility | | $895.40 | $1,397.49 | $3,361.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $718.61 / $1,232.13 / $2,647.13
| Facility | | $718.61 | $1,232.13 | $2,647.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $173.14 / $386.97 / $1,128.70
| Facility | | $173.14 | $386.97 | $1,128.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,224.00 / $3,500.00 / $6,361.00
| Facility | | $1,224.00 | $3,500.00 | $6,361.00 |