- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $75.86 / $275.42 / $275.42
| Facility | | $75.86 | $275.42 | $275.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $186.21 / $1,174.90 / $2,818.38
| Facility | | $186.21 | $1,174.90 | $2,818.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $676.08 / $954.99 / $2,238.72
| Facility | | $676.08 | $954.99 | $2,238.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $724.44 / $912.01 / $1,778.28
| Facility | | $724.44 | $912.01 | $1,778.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $97.72 / $371.54 / $2,884.03
| Facility | | $97.72 | $371.54 | $2,884.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $2,187.76 / $4,265.80
| Facility | | $1,000.00 | $2,187.76 | $4,265.80 |