- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $577.54 / $577.54 / $577.54
| Facility | | $577.54 | $577.54 | $577.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $712.01 / $1,738.32 / $4,533.76
| Facility | | $712.01 | $1,738.32 | $4,533.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,395.75 / $1,980.37 / $4,764.06
| Facility | | $1,395.75 | $1,980.37 | $4,764.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,268.86 / $1,810.54 / $3,751.23
| Facility | | $1,268.86 | $1,810.54 | $3,751.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $605.30 / $976.06 / $1,684.78
| Facility | | $605.30 | $976.06 | $1,684.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $563.00 / $1,402.00 / $2,544.00
| Facility | | $563.00 | $1,402.00 | $2,544.00 |