- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $389.05 / $389.05 / $5,011.87
| Facility | | $389.05 | $389.05 | $5,011.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,290.87 / $4,570.88 / $8,912.51
| Facility | | $2,290.87 | $4,570.88 | $8,912.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,047.13 / $1,479.11 / $3,548.13
| Facility | | $1,047.13 | $1,479.11 | $3,548.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,148.15 / $1,412.54 / $2,818.38
| Facility | | $1,148.15 | $1,412.54 | $2,818.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $389.05 / $776.25 / $5,011.87
| Facility | | $389.05 | $776.25 | $5,011.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,398.83 / $4,786.30 / $8,912.51
| Facility | | $2,398.83 | $4,786.30 | $8,912.51 |