- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $306.08 / $306.08 / $306.08
| Facility | | $306.08 | $306.08 | $306.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $565.26 / $595.01 / $1,922.70
| Facility | | $565.26 | $595.01 | $1,922.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $736.98 / $1,150.24 / $2,767.06
| Facility | | $736.98 | $1,150.24 | $2,767.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $736.98 / $946.63 / $2,178.79
| Facility | | $736.98 | $946.63 | $2,178.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $306.08 / $518.89 / $911.99
| Facility | | $306.08 | $518.89 | $911.99 |