- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $239.88 / $323.59 / $323.59
| Facility | | $239.88 | $323.59 | $323.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $602.56 / $660.69 / $2,344.23
| Facility | | $602.56 | $660.69 | $2,344.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $831.76 / $1,174.90 / $2,818.38
| Facility | | $831.76 | $1,174.90 | $2,818.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $912.01 / $1,148.15 / $2,187.76
| Facility | | $912.01 | $1,148.15 | $2,187.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $354.81 / $616.60 / $954.99
| Facility | | $354.81 | $616.60 | $954.99 |