- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $750.08 / $750.08 / $750.08
| Facility | | $750.08 | $750.08 | $750.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,549.76 / $6,299.85 / $12,503.65
| Facility | | $3,549.76 | $6,299.85 | $12,503.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,762.49 / $2,750.78 / $6,617.38
| Facility | | $1,762.49 | $2,750.78 | $6,617.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,527.35 / $2,510.27 / $5,210.54
| Facility | | $1,527.35 | $2,510.27 | $5,210.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $770.57 / $1,293.54 / $2,407.55
| Facility | | $770.57 | $1,293.54 | $2,407.55 |
- 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 |