- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $475.53 / $475.53 / $475.53
| Facility | | $475.53 | $475.53 | $475.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $914.84 / $1,966.91 / $3,970.57
| Facility | | $914.84 | $1,966.91 | $3,970.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,050.30 / $1,489.46 / $3,583.10
| Facility | | $1,050.30 | $1,489.46 | $3,583.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $853.82 / $1,361.72 / $2,821.34
| Facility | | $853.82 | $1,361.72 | $2,821.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $751.45 / $873.31 / $3,500.00
| Facility | | $751.45 | $873.31 | $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 |