- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $625.47 / $625.47 / $625.47
| Facility | | $625.47 | $625.47 | $625.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,088.76 / $3,706.82 / $6,499.58
| Facility | | $2,088.76 | $3,706.82 | $6,499.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,516.98 / $2,152.37 / $5,177.82
| Facility | | $1,516.98 | $2,152.37 | $5,177.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,379.07 / $1,967.78 / $4,077.03
| Facility | | $1,379.07 | $1,967.78 | $4,077.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $679.27 / $1,073.33 / $1,874.46
| Facility | | $679.27 | $1,073.33 | $1,874.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,457.00 / $9,370.00 / $12,774.00
| Facility | | $5,457.00 | $9,370.00 | $12,774.00 |