- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $523.11 / $523.11 / $523.11
| Facility | | $523.11 | $523.11 | $523.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,006.85 / $2,164.73 / $4,333.87
| Facility | | $1,006.85 | $2,164.73 | $4,333.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,154.74 / $1,637.57 / $3,939.40
| Facility | | $1,154.74 | $1,637.57 | $3,939.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $938.72 / $1,497.13 / $3,101.89
| Facility | | $938.72 | $1,497.13 | $3,101.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $827.86 / $962.10 / $3,500.00
| Facility | | $827.86 | $962.10 | $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 |