- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $990.15 / $990.15 / $990.15
| Facility | | $990.15 | $990.15 | $990.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,527.12 / $3,895.97 / $8,389.15
| Facility | | $1,527.12 | $3,895.97 | $8,389.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,317.33 / $3,616.75 / $8,700.58
| Facility | | $2,317.33 | $3,616.75 | $8,700.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,008.17 / $3,300.52 / $6,850.85
| Facility | | $2,008.17 | $3,300.52 | $6,850.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,026.98 / $1,798.24 / $3,146.18
| Facility | | $1,026.98 | $1,798.24 | $3,146.18 |
- 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 |