- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $144.04 / $144.04 / $144.04
| Facility | | $144.04 | $144.04 | $144.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $645.67 / $1,190.60 / $2,322.50
| Facility | | $645.67 | $1,190.60 | $2,322.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $316.69 / $449.11 / $1,080.39
| Facility | | $316.69 | $449.11 | $1,080.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $257.45 / $410.59 / $850.70
| Facility | | $257.45 | $410.59 | $850.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $226.30 / $263.07 / $3,500.00
| Facility | | $226.30 | $263.07 | $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 |