- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $794.33 / $933.25 / $933.25
| Facility | | $794.33 | $933.25 | $933.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $660.69 / $1,819.70 / $2,398.83
| Facility | | $660.69 | $1,819.70 | $2,398.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $380.19 / $3,019.95 / $3,162.28
| Facility | | $380.19 | $3,019.95 | $3,162.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $21,877.62 / $21,877.62 / $81,283.05
| Facility | | $21,877.62 | $21,877.62 | $81,283.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $144.54 / $302.00 / $524.81
| Facility | | $144.54 | $302.00 | $524.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $41.69 / $213.80 / $1,698.24
| Facility | | $41.69 | $213.80 | $1,698.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $181.97 / $218.78 / $81,283.05
| Facility | | $181.97 | $218.78 | $81,283.05 |