- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $191.71 / $357.32 / $1,201.20
| Facility | | $191.71 | $357.32 | $1,201.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $407.92 / $916.65 / $1,574.61
| Facility | | $407.92 | $916.65 | $1,574.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $805.20 / $1,141.88 / $2,746.95
| Facility | | $805.20 | $1,141.88 | $2,746.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $634.02 / $1,043.95 / $2,162.94
| Facility | | $634.02 | $1,043.95 | $2,162.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $257.68 / $454.86 / $1,030.20
| Facility | | $257.68 | $454.86 | $1,030.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $563.00 / $1,749.00 / $2,883.00
| Facility | | $563.00 | $1,749.00 | $2,883.00 |