- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $658.34 / $658.34 / $658.34
| Facility | | $658.34 | $658.34 | $658.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,881.55 / $5,385.36 / $10,505.12
| Facility | | $2,881.55 | $5,385.36 | $10,505.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,536.29 / $2,178.65 / $5,241.04
| Facility | | $1,536.29 | $2,178.65 | $5,241.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,248.89 / $1,991.81 / $4,126.80
| Facility | | $1,248.89 | $1,991.81 | $4,126.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $882.16 / $1,277.84 / $11,496.00
| Facility | | $882.16 | $1,277.84 | $11,496.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,028.00 / $11,496.00 / $21,528.00
| Facility | | $5,028.00 | $11,496.00 | $21,528.00 |