- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $313.07 / $313.07 / $313.07
| Facility | | $313.07 | $313.07 | $313.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $596.09 / $1,281.58 / $2,571.71
| Facility | | $596.09 | $1,281.58 | $2,571.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $691.50 / $980.63 / $2,359.04
| Facility | | $691.50 | $980.63 | $2,359.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $562.14 / $896.53 / $1,857.51
| Facility | | $562.14 | $896.53 | $1,857.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $494.10 / $595.48 / $4,550.50
| Facility | | $494.10 | $595.48 | $4,550.50 |
- 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 |