- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $195.53 / $195.53 / $229.77
| Facility | | $195.53 | $195.53 | $229.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,352.69 / $3,570.02 / $4,713.43
| Facility | | $2,352.69 | $3,570.02 | $4,713.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $40.00 / $40.00 / $40.00
| Facility | | $40.00 | $40.00 | $40.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,656.00 / $8,813.00 / $19,124.00
| Facility | | $5,656.00 | $8,813.00 | $19,124.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $210.00 / $544.00 / $1,226.00
| Facility | | $210.00 | $544.00 | $1,226.00 |