- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $208.52 / $208.52 / $5,482.45
| Facility | | $208.52 | $208.52 | $5,482.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,311.56 / $3,084.88 / $6,762.24
| Facility | | $1,311.56 | $3,084.88 | $6,762.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $488.26 / $762.05 / $1,833.21
| Facility | | $488.26 | $762.05 | $1,833.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $423.12 / $695.42 / $1,443.48
| Facility | | $423.12 | $695.42 | $1,443.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $240.08 / $445.65 / $2,257.67
| Facility | | $240.08 | $445.65 | $2,257.67 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,224.00 / $3,500.00 / $6,275.86
| Facility | | $1,224.00 | $3,500.00 | $6,275.86 |