- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $158.49 / $309.03 / $10,000.00
| Facility | | $158.49 | $309.03 | $10,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $169.82 / $169.82 / $204.17
| Facility | | $169.82 | $169.82 | $204.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $269.15 / $269.15 / $269.15
| Facility | | $269.15 | $269.15 | $269.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,128.31 / $8,128.31 / $12,882.50
| Facility | | $8,128.31 | $8,128.31 | $12,882.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,230.27 / $1,230.27 / $7,762.47
| Facility | | $1,230.27 | $1,230.27 | $7,762.47 |