- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $237.71 / $237.71 / $237.71
| Facility | | $237.71 | $237.71 | $237.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $456.10 / $980.63 / $1,976.70
| Facility | | $456.10 | $980.63 | $1,976.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $526.41 / $746.52 / $1,795.86
| Facility | | $526.41 | $746.52 | $1,795.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $427.94 / $682.50 / $1,414.06
| Facility | | $427.94 | $682.50 | $1,414.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $375.74 / $436.67 / $3,500.00
| Facility | | $375.74 | $436.67 | $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 |