- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $251.36 / $251.36 / $251.36
| Facility | | $251.36 | $251.36 | $251.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,226.30 / $5,014.17 / $11,327.71
| Facility | | $1,226.30 | $5,014.17 | $11,327.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $540.29 / $843.27 / $2,028.60
| Facility | | $540.29 | $843.27 | $2,028.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $468.22 / $769.54 / $1,597.33
| Facility | | $468.22 | $769.54 | $1,597.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $251.48 / $425.63 / $790.94
| Facility | | $251.48 | $425.63 | $790.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $796.00 / $3,500.00 / $8,152.00
| Facility | | $796.00 | $3,500.00 | $8,152.00 |