- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $696.48 / $696.48 / $696.48
| Facility | | $696.48 | $696.48 | $696.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $715.05 / $1,773.17 / $6,734.91
| Facility | | $715.05 | $1,773.17 | $6,734.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,742.64 / $2,471.29 / $5,945.01
| Facility | | $1,742.64 | $2,471.29 | $5,945.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,416.64 / $2,259.35 / $4,681.10
| Facility | | $1,416.64 | $2,259.35 | $4,681.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $773.32 / $1,177.05 / $2,131.67
| Facility | | $773.32 | $1,177.05 | $2,131.67 |
- 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 |