- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $134.90 / $794.33 / $794.33
| Facility | | $134.90 | $794.33 | $794.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $891.25 / $3,630.78 / $8,709.64
| Facility | | $891.25 | $3,630.78 | $8,709.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,862.09 / $3,019.95 / $7,079.46
| Facility | | $1,862.09 | $3,019.95 | $7,079.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,290.87 / $2,754.23 / $5,623.41
| Facility | | $2,290.87 | $2,754.23 | $5,623.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $158.49 / $812.83 / $2,344.23
| Facility | | $158.49 | $812.83 | $2,344.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,445.44 / $3,467.37 / $6,456.54
| Facility | | $1,445.44 | $3,467.37 | $6,456.54 |