- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $345.79 / $345.79 / $345.79
| Facility | | $345.79 | $345.79 | $345.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $659.84 / $1,418.66 / $2,852.06
| Facility | | $659.84 | $1,418.66 | $2,852.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $764.78 / $1,084.55 / $2,609.02
| Facility | | $764.78 | $1,084.55 | $2,609.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $621.71 / $991.54 / $2,054.35
| Facility | | $621.71 | $991.54 | $2,054.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $546.05 / $634.62 / $3,500.00
| Facility | | $546.05 | $634.62 | $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 |