- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $969.85 / $969.85 / $969.85
| Facility | | $969.85 | $969.85 | $969.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,901.38 / $9,212.18 / $20,811.61
| Facility | | $1,901.38 | $9,212.18 | $20,811.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,256.87 / $3,522.39 / $8,473.58
| Facility | | $2,256.87 | $3,522.39 | $8,473.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,955.78 / $3,214.41 / $6,672.11
| Facility | | $1,955.78 | $3,214.41 | $6,672.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $969.85 / $1,714.50 / $3,054.37
| Facility | | $969.85 | $1,714.50 | $3,054.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,623.00 / $4,746.00 / $8,812.00
| Facility | | $1,623.00 | $4,746.00 | $8,812.00 |