- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $630.96 / $776.25 / $776.25
| Facility | | $630.96 | $776.25 | $776.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,801.89 / $7,585.78 / $14,791.08
| Facility | | $3,801.89 | $7,585.78 | $14,791.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,041.74 / $2,884.03 / $6,760.83
| Facility | | $2,041.74 | $2,884.03 | $6,760.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,187.76 / $2,754.23 / $5,370.32
| Facility | | $2,187.76 | $2,754.23 | $5,370.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $691.83 / $1,288.25 / $2,754.23
| Facility | | $691.83 | $1,288.25 | $2,754.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,754.23 / $5,888.44 / $9,120.11
| Facility | | $2,754.23 | $5,888.44 | $9,120.11 |