- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $229.00 / $323.07 / $323.07
| Facility | | $229.00 | $323.07 | $323.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $547.52 / $636.72 / $1,812.15
| Facility | | $547.52 | $636.72 | $1,812.15 |
- 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
- $616.78 / $1,015.56 / $2,104.13
| Facility | | $616.78 | $1,015.56 | $2,104.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $305.17 / $553.01 / $843.40
| Facility | | $305.17 | $553.01 | $843.40 |