- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $335.17 / $335.17 / $335.17
| Facility | | $335.17 | $335.17 | $335.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $745.28 / $1,602.35 / $3,178.17
| Facility | | $745.28 | $1,602.35 | $3,178.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $778.31 / $1,214.74 / $2,922.22
| Facility | | $778.31 | $1,214.74 | $2,922.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $674.47 / $1,108.53 / $2,300.96
| Facility | | $674.47 | $1,108.53 | $2,300.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $372.28 / $611.54 / $1,076.77
| Facility | | $372.28 | $611.54 | $1,076.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $796.00 / $3,500.00 / $8,152.00
| Facility | | $796.00 | $3,500.00 | $8,152.00 |