- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $123.03 / $407.38 / $407.38
| Facility | | $123.03 | $407.38 | $407.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $794.33 / $3,630.78 / $8,709.64
| Facility | | $794.33 | $3,630.78 | $8,709.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $954.99 / $1,548.82 / $3,715.35
| Facility | | $954.99 | $1,548.82 | $3,715.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,202.26 / $1,412.54 / $2,884.03
| Facility | | $1,202.26 | $1,412.54 | $2,884.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $144.54 / $389.05 / $1,174.90
| Facility | | $144.54 | $389.05 | $1,174.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,513.56 / $3,548.13 / $8,912.51
| Facility | | $1,513.56 | $3,548.13 | $8,912.51 |