- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $721.08 / $721.08 / $721.08
| Facility | | $721.08 | $721.08 | $721.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,168.36 / $5,572.33 / $11,146.35
| Facility | | $3,168.36 | $5,572.33 | $11,146.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,683.69 / $2,387.67 / $5,743.88
| Facility | | $1,683.69 | $2,387.67 | $5,743.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,368.72 / $2,182.91 / $4,522.74
| Facility | | $1,368.72 | $2,182.91 | $4,522.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $970.00 / $1,299.98 / $3,378.00
| Facility | | $970.00 | $1,299.98 | $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 |