- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $125.89 / $398.11 / $446.68
| Facility | | $125.89 | $398.11 | $446.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $831.76 / $1,995.26 / $4,265.80
| Facility | | $831.76 | $1,995.26 | $4,265.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $954.99 / $1,513.56 / $3,630.78
| Facility | | $954.99 | $1,513.56 | $3,630.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,174.90 / $1,445.44 / $2,818.38
| Facility | | $1,174.90 | $1,445.44 | $2,818.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $158.49 / $416.87 / $1,202.26
| Facility | | $158.49 | $416.87 | $1,202.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,445.44 / $2,691.53 / $6,456.54
| Facility | | $1,445.44 | $2,691.53 | $6,456.54 |