- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $977.12 / $977.12 / $977.12
| Facility | | $977.12 | $977.12 | $977.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,850.70 / $3,949.72 / $7,749.47
| Facility | | $1,850.70 | $3,949.72 | $7,749.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,178.09 / $3,088.81 / $7,430.55
| Facility | | $2,178.09 | $3,088.81 | $7,430.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,770.63 / $2,823.91 / $5,850.83
| Facility | | $1,770.63 | $2,823.91 | $5,850.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,302.34 / $1,803.51 / $3,500.00
| Facility | | $1,302.34 | $1,803.51 | $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 |