- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $705.22 / $705.22 / $705.22
| Facility | | $705.22 | $705.22 | $705.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,178.08 / $3,144.69 / $6,087.06
| Facility | | $1,178.08 | $3,144.69 | $6,087.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,653.05 / $2,579.98 / $6,206.49
| Facility | | $1,653.05 | $2,579.98 | $6,206.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,432.51 / $2,354.40 / $4,887.00
| Facility | | $1,432.51 | $2,354.40 | $4,887.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $750.00 / $1,263.01 / $2,245.34
| Facility | | $750.00 | $1,263.01 | $2,245.34 |
- 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 |