- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $512.86 / $512.86 / $512.86
| Facility | | $512.86 | $512.86 | $512.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,311.31 / $21,877.62 / $51,286.14
| Facility | | $3,311.31 | $21,877.62 | $51,286.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,348.96 / $1,949.84 / $4,570.88
| Facility | | $1,348.96 | $1,949.84 | $4,570.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,479.11 / $1,862.09 / $3,630.78
| Facility | | $1,479.11 | $1,862.09 | $3,630.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $616.60 / $1,071.52 / $3,467.37
| Facility | | $616.60 | $1,071.52 | $3,467.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,584.89 / $3,467.37 / $8,511.38
| Facility | | $1,584.89 | $3,467.37 | $8,511.38 |