- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $213.80 / $213.80 / $213.80
| Facility | | $213.80 | $213.80 | $213.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $575.44 / $10,715.19 / $26,302.68
| Facility | | $575.44 | $10,715.19 | $26,302.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $501.19 / $812.83 / $1,949.84
| Facility | | $501.19 | $812.83 | $1,949.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $616.60 / $776.25 / $1,513.56
| Facility | | $616.60 | $776.25 | $1,513.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $229.09 / $354.81 / $2,089.30
| Facility | | $229.09 | $354.81 | $2,089.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,290.87 / $6,456.54 / $11,748.98
| Facility | | $2,290.87 | $6,456.54 | $11,748.98 |