- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $891.25 / $891.25 / $1,737.80
| Facility | | $891.25 | $891.25 | $1,737.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $281.84 / $281.84 / $338.84
| Facility | | $281.84 | $281.84 | $338.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $34.67 / $457.09 / $457.09
| Facility | | $34.67 | $457.09 | $457.09 |
- Facility/Professional
- Facility
- Modifier
- 22
- Low / Median / High Price
- $549.54 / $549.54 / $549.54
| Facility | 22 | $549.54 | $549.54 | $549.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,584.89 / $1,584.89 / $8,128.31
| Facility | | $1,584.89 | $1,584.89 | $8,128.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,230.27 / $1,230.27 / $5,370.32
| Facility | | $1,230.27 | $1,230.27 | $5,370.32 |