- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $100.40 / $378.56 / $4,311.00
| Facility | | $100.40 | $378.56 | $4,311.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $511.52 / $562.66 / $954.83
| Facility | | $511.52 | $562.66 | $954.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $323.44 / $842.52 / $1,675.01
| Facility | | $323.44 | $842.52 | $1,675.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $101.45 / $343.92 / $521.23
| Facility | | $101.45 | $343.92 | $521.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $393.00 / $650.00 / $4,824.00
| Facility | | $393.00 | $650.00 | $4,824.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $696.72 / $696.72 / $12,000.00
| Facility | | $696.72 | $696.72 | $12,000.00 |