- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $775.72 / $775.72 / $775.72
| Facility | | $775.72 | $775.72 | $775.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,485.20 / $5,792.97 / $11,146.35
| Facility | | $3,485.20 | $5,792.97 | $11,146.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,841.19 / $2,611.03 / $6,281.20
| Facility | | $1,841.19 | $2,611.03 | $6,281.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,496.75 / $2,387.11 / $4,945.83
| Facility | | $1,496.75 | $2,387.11 | $4,945.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,052.39 / $1,436.30 / $3,378.00
| Facility | | $1,052.39 | $1,436.30 | $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 |