- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $649.71 / $649.71 / $649.71
| Facility | | $649.71 | $649.71 | $649.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,184.84 / $1,457.06 / $2,688.96
| Facility | | $1,184.84 | $1,457.06 | $2,688.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,433.53 / $2,032.93 / $4,890.47
| Facility | | $1,433.53 | $2,032.93 | $4,890.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,165.35 / $1,858.58 / $3,850.78
| Facility | | $1,165.35 | $1,858.58 | $3,850.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $716.96 / $1,188.85 / $3,500.00
| Facility | | $716.96 | $1,188.85 | $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 |