- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $507.93 / $507.93 / $507.93
| Facility | | $507.93 | $507.93 | $507.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $939.07 / $988.49 / $3,088.80
| Facility | | $939.07 | $988.49 | $3,088.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,222.95 / $1,908.71 / $4,591.64
| Facility | | $1,222.95 | $1,908.71 | $4,591.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,222.95 / $1,570.83 / $3,615.48
| Facility | | $1,222.95 | $1,570.83 | $3,615.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $507.93 / $858.40 / $1,506.87
| Facility | | $507.93 | $858.40 | $1,506.87 |