- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $181.97 / $707.95 / $707.95
| Facility | | $181.97 | $707.95 | $707.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,202.26 / $7,244.36 / $17,378.01
| Facility | | $1,202.26 | $7,244.36 | $17,378.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,659.59 / $2,691.53 / $6,456.54
| Facility | | $1,659.59 | $2,691.53 | $6,456.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,041.74 / $2,570.40 / $5,011.87
| Facility | | $2,041.74 | $2,570.40 | $5,011.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $208.93 / $676.08 / $2,041.74
| Facility | | $208.93 | $676.08 | $2,041.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,445.44 / $5,248.07 / $9,332.54
| Facility | | $1,445.44 | $5,248.07 | $9,332.54 |