- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $355.06 / $355.06 / $355.06
| Facility | | $355.06 | $355.06 | $355.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $678.24 / $1,458.22 / $2,940.73
| Facility | | $678.24 | $1,458.22 | $2,940.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $783.31 / $1,110.82 / $2,672.24
| Facility | | $783.31 | $1,110.82 | $2,672.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $636.77 / $1,015.56 / $2,104.13
| Facility | | $636.77 | $1,015.56 | $2,104.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $505.25 / $647.41 / $3,500.00
| Facility | | $505.25 | $647.41 | $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 |