- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $439.20 / $439.20 / $439.20
| Facility | | $439.20 | $439.20 | $439.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,007.85 / $21,428.46 / $48,409.91
| Facility | | $1,007.85 | $21,428.46 | $48,409.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,078.09 / $1,528.88 / $3,677.92
| Facility | | $1,078.09 | $1,528.88 | $3,677.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $876.42 / $1,397.76 / $2,896.00
| Facility | | $876.42 | $1,397.76 | $2,896.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $654.94 / $831.88 / $3,378.00
| Facility | | $654.94 | $831.88 | $3,378.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,751.00 / $3,500.00 / $8,152.00
| Facility | | $1,751.00 | $3,500.00 | $8,152.00 |