- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $880.11 / $880.11 / $880.11
| Facility | | $880.11 | $880.11 | $880.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,173.08 / $2,992.74 / $7,369.30
| Facility | | $1,173.08 | $2,992.74 | $7,369.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,049.46 / $3,198.70 / $7,694.90
| Facility | | $2,049.46 | $3,198.70 | $7,694.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,776.05 / $2,919.02 / $6,058.98
| Facility | | $1,776.05 | $2,919.02 | $6,058.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $927.87 / $1,598.00 / $2,784.32
| Facility | | $927.87 | $1,598.00 | $2,784.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $796.00 / $3,500.00 / $8,152.00
| Facility | | $796.00 | $3,500.00 | $8,152.00 |