- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $950.36 / $950.36 / $950.36
| Facility | | $950.36 | $950.36 | $950.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,184.29 / $6,737.76 / $13,020.23
| Facility | | $4,184.29 | $6,737.76 | $13,020.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,349.92 / $3,332.47 / $8,016.72
| Facility | | $2,349.92 | $3,332.47 | $8,016.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,910.31 / $3,046.68 / $6,312.38
| Facility | | $1,910.31 | $3,046.68 | $6,312.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,244.44 / $1,751.00 / $3,378.00
| Facility | | $1,244.44 | $1,751.00 | $3,378.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,751.00 / $3,500.00 / $8,152.00
| Facility | | $1,751.00 | $3,500.00 | $8,152.00 |