- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $541.76 / $541.76 / $541.76
| Facility | | $541.76 | $541.76 | $541.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $988.72 / $1,214.58 / $2,243.85
| Facility | | $988.72 | $1,214.58 | $2,243.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,195.17 / $1,694.90 / $4,077.32
| Facility | | $1,195.17 | $1,694.90 | $4,077.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $971.59 / $1,549.55 / $3,210.49
| Facility | | $971.59 | $1,549.55 | $3,210.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $542.80 / $990.85 / $3,500.00
| Facility | | $542.80 | $990.85 | $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 |