- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $245.19 / $627.17 / $627.17
| Facility | | $245.19 | $627.17 | $627.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,109.67 / $3,346.04 / $6,480.74
| Facility | | $1,109.67 | $3,346.04 | $6,480.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,381.37 / $2,155.96 / $5,186.43
| Facility | | $1,381.37 | $2,155.96 | $5,186.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,235.88 / $1,971.06 / $4,083.81
| Facility | | $1,235.88 | $1,971.06 | $4,083.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $271.32 / $627.17 / $1,615.32
| Facility | | $271.32 | $627.17 | $1,615.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,388.00 / $3,500.00 / $6,361.00
| Facility | | $1,388.00 | $3,500.00 | $6,361.00 |