- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $168.24 / $168.24 / $168.24
| Facility | | $168.24 | $168.24 | $168.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $829.67 / $5,014.17 / $11,327.71
| Facility | | $829.67 | $5,014.17 | $11,327.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $373.12 / $529.13 / $1,272.91
| Facility | | $373.12 | $529.13 | $1,272.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $303.32 / $483.76 / $1,002.29
| Facility | | $303.32 | $483.76 | $1,002.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $265.25 / $309.27 / $3,500.00
| Facility | | $265.25 | $309.27 | $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 |