- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $977.24 / $3,715.35 / $12,882.50
| Facility | | $977.24 | $3,715.35 | $12,882.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $208.93 / $208.93 / $208.93
| Facility | | $208.93 | $208.93 | $208.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $54.95 / $56.23 / $1,412.54
| Facility | | $54.95 | $56.23 | $1,412.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $323.59 / $2,187.76 / $8,511.38
| Facility | | $323.59 | $2,187.76 | $8,511.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $229.09 / $323.59 / $562.34
| Facility | | $229.09 | $323.59 | $562.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $436.52 / $2,454.71 / $10,232.93
| Facility | | $436.52 | $2,454.71 | $10,232.93 |