- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $841.61 / $841.61 / $841.61
| Facility | | $841.61 | $841.61 | $841.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,601.62 / $3,443.49 / $7,260.31
| Facility | | $1,601.62 | $3,443.49 | $7,260.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,868.98 / $2,650.45 / $6,376.02
| Facility | | $1,868.98 | $2,650.45 | $6,376.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,519.35 / $2,423.15 / $5,020.49
| Facility | | $1,519.35 | $2,423.15 | $5,020.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,107.70 / $1,559.91 / $3,500.00
| Facility | | $1,107.70 | $1,559.91 | $3,500.00 |
- 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 |