- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $597.27 / $597.27 / $597.27
| Facility | | $597.27 | $597.27 | $597.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,068.03 / $1,293.86 / $2,437.42
| Facility | | $1,068.03 | $1,293.86 | $2,437.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,328.25 / $1,883.62 / $4,531.31
| Facility | | $1,328.25 | $1,883.62 | $4,531.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,079.77 / $1,722.08 / $3,567.96
| Facility | | $1,079.77 | $1,722.08 | $3,567.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $857.99 / $1,164.27 / $3,500.00
| Facility | | $857.99 | $1,164.27 | $3,500.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,751.00 / $3,500.00 / $8,152.00
| Facility | | $1,751.00 | $3,500.00 | $8,152.00 |