- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $162.18 / $162.18 / $162.18
| Facility | | $162.18 | $162.18 | $162.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $350.29 / $753.13 / $1,498.98
| Facility | | $350.29 | $753.13 | $1,498.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $405.13 / $574.52 / $1,382.09
| Facility | | $405.13 | $574.52 | $1,382.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $329.34 / $525.25 / $1,088.26
| Facility | | $329.34 | $525.25 | $1,088.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $239.56 / $313.16 / $3,378.00
| Facility | | $239.56 | $313.16 | $3,378.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,445.00 / $3,236.00 / $5,530.00
| Facility | | $1,445.00 | $3,236.00 | $5,530.00 |