- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $147.91 / $147.91 / $147.91
| Facility | | $147.91 | $147.91 | $147.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $371.54 / $5,248.07 / $13,182.57
| Facility | | $371.54 | $5,248.07 | $13,182.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $363.08 / $512.86 / $1,230.27
| Facility | | $363.08 | $512.86 | $1,230.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $398.11 / $489.78 / $954.99
| Facility | | $398.11 | $489.78 | $954.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $173.78 / $295.12 / $3,467.37
| Facility | | $173.78 | $295.12 | $3,467.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,584.89 / $3,467.37 / $8,511.38
| Facility | | $1,584.89 | $3,467.37 | $8,511.38 |