- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $905.13 / $905.13 / $905.13
| Facility | | $905.13 | $905.13 | $905.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,696.02 / $3,789.68 / $7,640.77
| Facility | | $1,696.02 | $3,789.68 | $7,640.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,110.71 / $2,993.25 / $7,200.68
| Facility | | $2,110.71 | $2,993.25 | $7,200.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,715.86 / $2,736.55 / $5,669.83
| Facility | | $1,715.86 | $2,736.55 | $5,669.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,131.80 / $1,632.00 / $3,378.00
| Facility | | $1,131.80 | $1,632.00 | $3,378.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,751.00 / $3,500.00 / $8,152.00
| Facility | | $1,751.00 | $3,500.00 | $8,152.00 |