- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $488.75 / $2,162.10 / $2,486.42
| Facility | | $488.75 | $2,162.10 | $2,486.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $515.50 / $515.50 / $515.50
| Facility | | $515.50 | $515.50 | $515.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,181.00 / $1,181.00 / $1,181.00
| Facility | | $1,181.00 | $1,181.00 | $1,181.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $550.00 / $605.00 / $983.51
| Facility | | $550.00 | $605.00 | $983.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $400.00 / $543.00 / $629.44
| Facility | | $400.00 | $543.00 | $629.44 |