- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $144.54 / $144.54 / $144.54
| Facility | | $144.54 | $144.54 | $144.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $812.83 / $1,445.44 / $3,311.31
| Facility | | $812.83 | $1,445.44 | $3,311.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $338.84 / $478.63 / $1,122.02
| Facility | | $338.84 | $478.63 | $1,122.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $363.08 / $457.09 / $891.25
| Facility | | $363.08 | $457.09 | $891.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $204.17 / $295.12 / $3,981.07
| Facility | | $204.17 | $295.12 | $3,981.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,584.89 / $3,467.37 / $8,511.38
| Facility | | $1,584.89 | $3,467.37 | $8,511.38 |