- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $165.96 / $870.96 / $5,011.87
| Facility | | $165.96 | $870.96 | $5,011.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,801.89 / $8,317.64 / $13,803.84
| Facility | | $3,801.89 | $8,317.64 | $13,803.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $199.53 / $199.53 / $199.53
| Facility | | $199.53 | $199.53 | $199.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $109.65 / $151.36 / $269.15
| Facility | | $109.65 | $151.36 | $269.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $93.33 / $794.33 / $1,412.54
| Facility | | $93.33 | $794.33 | $1,412.54 |