- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $95.50 / $257.04 / $257.04
| Facility | | $95.50 | $257.04 | $257.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $616.60 / $3,630.78 / $8,709.64
| Facility | | $616.60 | $3,630.78 | $8,709.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $602.56 / $977.24 / $2,344.23
| Facility | | $602.56 | $977.24 | $2,344.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $758.58 / $933.25 / $1,819.70
| Facility | | $758.58 | $933.25 | $1,819.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $117.49 / $288.40 / $758.58
| Facility | | $117.49 | $288.40 | $758.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,445.44 / $3,467.37 / $6,456.54
| Facility | | $1,445.44 | $3,467.37 | $6,456.54 |