- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $76.73 / $76.73 / $76.73
| Facility | | $76.73 | $76.73 | $76.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $169.46 / $5,064.68 / $11,441.84
| Facility | | $169.46 | $5,064.68 | $11,441.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $188.67 / $267.55 / $643.64
| Facility | | $188.67 | $267.55 | $643.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $153.37 / $244.61 / $506.80
| Facility | | $153.37 | $244.61 | $506.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $107.10 / $145.62 / $3,378.00
| Facility | | $107.10 | $145.62 | $3,378.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,751.00 / $3,500.00 / $8,152.00
| Facility | | $1,751.00 | $3,500.00 | $8,152.00 |