- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $523.12 / $523.12 / $523.12
| Facility | | $523.12 | $523.12 | $523.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $953.86 / $1,173.80 / $2,164.73
| Facility | | $953.86 | $1,173.80 | $2,164.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,153.90 / $1,636.38 / $3,936.52
| Facility | | $1,153.90 | $1,636.38 | $3,936.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $938.04 / $1,496.04 / $3,099.63
| Facility | | $938.04 | $1,496.04 | $3,099.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $447.33 / $956.79 / $3,500.00
| Facility | | $447.33 | $956.79 | $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 |