- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $205.36 / $205.36 / $205.36
| Facility | | $205.36 | $205.36 | $205.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $404.84 / $870.41 / $1,776.46
| Facility | | $404.84 | $870.41 | $1,776.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $475.04 / $673.66 / $1,620.58
| Facility | | $475.04 | $673.66 | $1,620.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $386.17 / $615.89 / $1,276.05
| Facility | | $386.17 | $615.89 | $1,276.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $264.92 / $392.81 / $3,500.00
| Facility | | $264.92 | $392.81 | $3,500.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,751.00 / $3,500.00 / $8,152.00
| Facility | | $1,751.00 | $3,500.00 | $8,152.00 |