- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $283.01 / $283.01 / $283.01
| Facility | | $283.01 | $283.01 | $283.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $545.48 / $1,172.78 / $2,360.03
| Facility | | $545.48 | $1,172.78 | $2,360.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $624.96 / $886.27 / $2,132.04
| Facility | | $624.96 | $886.27 | $2,132.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $508.05 / $810.26 / $1,678.78
| Facility | | $508.05 | $810.26 | $1,678.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $446.37 / $518.75 / $3,500.00
| Facility | | $446.37 | $518.75 | $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 |