- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $975.97 / $975.97 / $975.97
| Facility | | $975.97 | $975.97 | $975.97 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,696.02 / $4,084.38 / $8,204.31
| Facility | | $1,696.02 | $4,084.38 | $8,204.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,266.53 / $3,214.22 / $7,732.25
| Facility | | $2,266.53 | $3,214.22 | $7,732.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,842.53 / $2,938.57 / $6,088.39
| Facility | | $1,842.53 | $2,938.57 | $6,088.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,226.58 / $1,751.00 / $3,378.00
| Facility | | $1,226.58 | $1,751.00 | $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 |