- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $107.15 / $912.01 / $912.01
| Facility | | $107.15 | $912.01 | $912.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $707.95 / $3,630.78 / $8,709.64
| Facility | | $707.95 | $3,630.78 | $8,709.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,089.30 / $3,388.44 / $8,128.31
| Facility | | $2,089.30 | $3,388.44 | $8,128.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,630.27 / $3,235.94 / $6,456.54
| Facility | | $2,630.27 | $3,235.94 | $6,456.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $125.89 / $354.81 / $2,511.89
| Facility | | $125.89 | $354.81 | $2,511.89 |
- 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 |