- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $917.62 / $917.62 / $917.62
| Facility | | $917.62 | $917.62 | $917.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,178.08 / $3,144.69 / $7,607.11
| Facility | | $1,178.08 | $3,144.69 | $7,607.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,141.31 / $3,342.03 / $8,039.70
| Facility | | $2,141.31 | $3,342.03 | $8,039.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,855.63 / $3,049.82 / $6,330.48
| Facility | | $1,855.63 | $3,049.82 | $6,330.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $955.42 / $1,667.70 / $2,913.06
| Facility | | $955.42 | $1,667.70 | $2,913.06 |
- 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 |