- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $213.80 / $3,311.31 / $4,073.80
| Facility | | $213.80 | $3,311.31 | $4,073.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1.00 / $1,905.46 / $4,570.88
| Facility | | $1.00 | $1,905.46 | $4,570.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $446.68 / $630.96 / $1,513.56
| Facility | | $446.68 | $630.96 | $1,513.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $489.78 / $602.56 / $1,202.26
| Facility | | $489.78 | $602.56 | $1,202.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $218.78 / $363.08 / $1,513.56
| Facility | | $218.78 | $363.08 | $1,513.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,584.89 / $2,951.21 / $4,265.80
| Facility | | $1,584.89 | $2,951.21 | $4,265.80 |