- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $134.90 / $251.19 / $389.05
| Facility | | $134.90 | $251.19 | $389.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $776.25 / $2,691.53 / $5,011.87
| Facility | | $776.25 | $2,691.53 | $5,011.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $316.23 / $1,202.26 / $2,818.38
| Facility | | $316.23 | $1,202.26 | $2,818.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $120.23 / $269.15 / $6,025.60
| Facility | | $120.23 | $269.15 | $6,025.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $204.17 / $263.03 / $398.11
| Facility | | $204.17 | $263.03 | $398.11 |