- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $231.87 / $231.87 / $231.87
| Facility | | $231.87 | $231.87 | $231.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $468.69 / $9,238.04 / $20,312.33
| Facility | | $468.69 | $9,238.04 | $20,312.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $508.73 / $721.44 / $1,735.52
| Facility | | $508.73 | $721.44 | $1,735.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $413.56 / $659.57 / $1,366.55
| Facility | | $413.56 | $659.57 | $1,366.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $352.21 / $421.49 / $3,500.00
| Facility | | $352.21 | $421.49 | $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 |