- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $152.36 / $152.36 / $152.36
| Facility | | $152.36 | $152.36 | $152.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,547.24 / $20,448.87 / $39,554.72
| Facility | | $15,547.24 | $20,448.87 | $39,554.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $194.26 / $303.69 / $2,647.00
| Facility | | $194.26 | $303.69 | $2,647.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $306.32 / $380.67 / $443.00
| Facility | | $306.32 | $380.67 | $443.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,031.00 / $1,775.00 / $4,406.00
| Facility | | $1,031.00 | $1,775.00 | $4,406.00 |