- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $172.77 / $172.77 / $172.77
| Facility | | $172.77 | $172.77 | $172.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $130.72 / $349.36 / $1,010.52
| Facility | | $130.72 | $349.36 | $1,010.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $380.70 / $539.88 / $1,298.77
| Facility | | $380.70 | $539.88 | $1,298.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $309.48 / $493.58 / $1,022.65
| Facility | | $309.48 | $493.58 | $1,022.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $269.20 / $316.70 / $3,500.00
| Facility | | $269.20 | $316.70 | $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 |