- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $188.21 / $188.21 / $188.21
| Facility | | $188.21 | $188.21 | $188.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $945.40 / $5,014.17 / $11,327.71
| Facility | | $945.40 | $5,014.17 | $11,327.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $417.76 / $592.44 / $1,425.19
| Facility | | $417.76 | $592.44 | $1,425.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $339.61 / $541.63 / $1,122.20
| Facility | | $339.61 | $541.63 | $1,122.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $297.52 / $345.76 / $3,500.00
| Facility | | $297.52 | $345.76 | $3,500.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,751.00 / $3,500.00 / $8,152.00
| Facility | | $1,751.00 | $3,500.00 | $8,152.00 |