- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $302.00 / $489.78 / $489.78
| Facility | | $302.00 | $489.78 | $489.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,737.80 / $4,677.35 / $10,715.19
| Facility | | $1,737.80 | $4,677.35 | $10,715.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,202.26 / $1,698.24 / $3,981.07
| Facility | | $1,202.26 | $1,698.24 | $3,981.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,288.25 / $1,621.81 / $3,162.28
| Facility | | $1,288.25 | $1,621.81 | $3,162.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $323.59 / $602.56 / $1,348.96
| Facility | | $323.59 | $602.56 | $1,348.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,884.03 / $5,248.07 / $8,912.51
| Facility | | $2,884.03 | $5,248.07 | $8,912.51 |