- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $963.92 / $963.92 / $963.92
| Facility | | $963.92 | $963.92 | $963.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,178.08 / $3,144.69 / $8,031.02
| Facility | | $1,178.08 | $3,144.69 | $8,031.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,243.86 / $3,502.08 / $8,424.74
| Facility | | $2,243.86 | $3,502.08 | $8,424.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,944.50 / $3,195.88 / $6,633.65
| Facility | | $1,944.50 | $3,195.88 | $6,633.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,027.77 / $1,751.00 / $3,059.01
| Facility | | $1,027.77 | $1,751.00 | $3,059.01 |
- 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 |