- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $148.87 / $148.87 / $148.87
| Facility | | $148.87 | $148.87 | $148.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $663.70 / $1,190.60 / $2,356.96
| Facility | | $663.70 | $1,190.60 | $2,356.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $328.48 / $465.83 / $1,120.61
| Facility | | $328.48 | $465.83 | $1,120.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $267.02 / $425.88 / $882.38
| Facility | | $267.02 | $425.88 | $882.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $231.10 / $272.10 / $3,500.00
| Facility | | $231.10 | $272.10 | $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 |