- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $200.27 / $200.27 / $200.27
| Facility | | $200.27 | $200.27 | $200.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,474.84 / $7,700.77 / $16,389.55
| Facility | | $1,474.84 | $7,700.77 | $16,389.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $472.51 / $670.08 / $1,611.96
| Facility | | $472.51 | $670.08 | $1,611.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $384.12 / $612.61 / $1,269.26
| Facility | | $384.12 | $612.61 | $1,269.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $300.45 / $373.30 / $3,378.00
| Facility | | $300.45 | $373.30 | $3,378.00 |
- 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 |