- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $312.23 / $312.23 / $312.23
| Facility | | $312.23 | $312.23 | $312.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,643.08 / $5,434.68 / $11,327.71
| Facility | | $1,643.08 | $5,434.68 | $11,327.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $724.74 / $1,131.13 / $2,721.09
| Facility | | $724.74 | $1,131.13 | $2,721.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $628.04 / $1,032.23 / $2,142.59
| Facility | | $628.04 | $1,032.23 | $2,142.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $346.61 / $569.87 / $1,061.63
| Facility | | $346.61 | $569.87 | $1,061.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,960.00 / $7,872.00 / $11,531.00
| Facility | | $2,960.00 | $7,872.00 | $11,531.00 |