- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $158.49 / $416.87 / $416.87
| Facility | | $158.49 | $416.87 | $416.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $416.87 / $2,238.72 / $5,370.32
| Facility | | $416.87 | $2,238.72 | $5,370.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $977.24 / $1,584.89 / $3,801.89
| Facility | | $977.24 | $1,584.89 | $3,801.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,230.27 / $1,513.56 / $2,951.21
| Facility | | $1,230.27 | $1,513.56 | $2,951.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $186.21 / $457.09 / $1,230.27
| Facility | | $186.21 | $457.09 | $1,230.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,230.27 / $3,090.30 / $6,456.54
| Facility | | $1,230.27 | $3,090.30 | $6,456.54 |