- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $668.65 / $668.65 / $668.65
| Facility | | $668.65 | $668.65 | $668.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,083.23 / $6,134.65 / $11,966.76
| Facility | | $3,083.23 | $6,134.65 | $11,966.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,608.74 / $2,282.57 / $5,491.02
| Facility | | $1,608.74 | $2,282.57 | $5,491.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,462.49 / $2,086.81 / $4,323.64
| Facility | | $1,462.49 | $2,086.81 | $4,323.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $734.64 / $1,148.13 / $2,000.99
| Facility | | $734.64 | $1,148.13 | $2,000.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,457.00 / $9,370.00 / $12,774.00
| Facility | | $5,457.00 | $9,370.00 | $12,774.00 |