- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $315.81 / $315.81 / $315.81
| Facility | | $315.81 | $315.81 | $315.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,558.28 / $5,898.73 / $12,294.94
| Facility | | $1,558.28 | $5,898.73 | $12,294.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $732.39 / $1,143.07 / $2,749.82
| Facility | | $732.39 | $1,143.07 | $2,749.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $634.67 / $1,043.13 / $2,165.21
| Facility | | $634.67 | $1,043.13 | $2,165.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $344.17 / $670.59 / $1,303.44
| Facility | | $344.17 | $670.59 | $1,303.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,100.00 / $5,499.00 / $9,810.00
| Facility | | $2,100.00 | $5,499.00 | $9,810.00 |