- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $914.12 / $914.12 / $914.12
| Facility | | $914.12 | $914.12 | $914.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,178.08 / $3,144.69 / $7,537.32
| Facility | | $1,178.08 | $3,144.69 | $7,537.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,140.54 / $3,340.83 / $8,036.83
| Facility | | $2,140.54 | $3,340.83 | $8,036.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,854.97 / $3,048.73 / $6,328.21
| Facility | | $1,854.97 | $3,048.73 | $6,328.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $944.92 / $1,635.39 / $2,907.36
| Facility | | $944.92 | $1,635.39 | $2,907.36 |
- 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 |