- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $707.95 / $707.95 / $2,630.27
| Facility | | $707.95 | $707.95 | $2,630.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $954.99 / $3,090.30 / $7,413.10
| Facility | | $954.99 | $3,090.30 | $7,413.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,819.70 / $2,570.40 / $6,025.60
| Facility | | $1,819.70 | $2,570.40 | $6,025.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,949.84 / $2,454.71 / $4,786.30
| Facility | | $1,949.84 | $2,454.71 | $4,786.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $707.95 / $1,202.26 / $2,951.21
| Facility | | $707.95 | $1,202.26 | $2,951.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $977.24 / $2,238.72 / $4,265.80
| Facility | | $977.24 | $2,238.72 | $4,265.80 |