- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $429.70 / $429.70 / $429.70
| Facility | | $429.70 | $429.70 | $429.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $821.51 / $1,766.25 / $3,555.77
| Facility | | $821.51 | $1,766.25 | $3,555.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $949.23 / $1,346.13 / $3,238.29
| Facility | | $949.23 | $1,346.13 | $3,238.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $771.66 / $1,230.68 / $2,549.84
| Facility | | $771.66 | $1,230.68 | $2,549.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $677.04 / $786.84 / $3,954.00
| Facility | | $677.04 | $786.84 | $3,954.00 |
- 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 |