- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $707.95 / $707.95 / $5,011.87
| Facility | | $707.95 | $707.95 | $5,011.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,511.89 / $4,677.35 / $12,022.64
| Facility | | $2,511.89 | $4,677.35 | $12,022.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,819.70 / $2,570.40 / $6,165.95
| Facility | | $1,819.70 | $2,570.40 | $6,165.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,995.26 / $2,454.71 / $4,786.30
| Facility | | $1,995.26 | $2,454.71 | $4,786.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $707.95 / $1,318.26 / $3,981.07
| Facility | | $707.95 | $1,318.26 | $3,981.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,380.38 / $3,467.37 / $6,456.54
| Facility | | $1,380.38 | $3,467.37 | $6,456.54 |