- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $400.76 / $400.76 / $400.76
| Facility | | $400.76 | $400.76 | $400.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $712.01 / $1,716.52 / $3,192.57
| Facility | | $712.01 | $1,716.52 | $3,192.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $939.79 / $1,466.77 / $3,528.50
| Facility | | $939.79 | $1,466.77 | $3,528.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $814.41 / $1,338.52 / $2,778.35
| Facility | | $814.41 | $1,338.52 | $2,778.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $400.76 / $717.84 / $1,277.08
| Facility | | $400.76 | $717.84 | $1,277.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,623.00 / $4,746.00 / $8,812.00
| Facility | | $1,623.00 | $4,746.00 | $8,812.00 |