- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $156.65 / $156.65 / $156.65
| Facility | | $156.65 | $156.65 | $156.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $315.42 / $5,276.65 / $11,327.71
| Facility | | $315.42 | $5,276.65 | $11,327.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $345.33 / $489.72 / $1,178.08
| Facility | | $345.33 | $489.72 | $1,178.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $280.73 / $447.72 / $927.63
| Facility | | $280.73 | $447.72 | $927.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $239.86 / $286.81 / $3,500.00
| Facility | | $239.86 | $286.81 | $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 |