- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $275.42 / $346.74 / $346.74
| Facility | | $275.42 | $346.74 | $346.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $707.95 / $9,772.37 / $23,442.29
| Facility | | $707.95 | $9,772.37 | $23,442.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $933.25 / $1,318.26 / $3,162.28
| Facility | | $933.25 | $1,318.26 | $3,162.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,023.29 / $1,258.93 / $2,454.71
| Facility | | $1,023.29 | $1,258.93 | $2,454.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $389.05 / $588.84 / $4,677.35
| Facility | | $389.05 | $588.84 | $4,677.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $3,467.37 / $13,489.63
| Facility | | $1,000.00 | $3,467.37 | $13,489.63 |