- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $173.78 / $173.78 / $173.78
| Facility | | $173.78 | $173.78 | $173.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $64.57 / $2,570.40 / $5,754.40
| Facility | | $64.57 | $2,570.40 | $5,754.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $416.87 / $588.84 / $1,412.54
| Facility | | $416.87 | $588.84 | $1,412.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $457.09 / $562.34 / $1,096.48
| Facility | | $457.09 | $562.34 | $1,096.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $245.47 / $354.81 / $2,398.83
| Facility | | $245.47 | $354.81 | $2,398.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,584.89 / $2,951.21 / $7,079.46
| Facility | | $1,584.89 | $2,951.21 | $7,079.46 |