- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $707.95 / $891.25 / $891.25
| Facility | | $707.95 | $891.25 | $891.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,073.80 / $14,125.38 / $32,359.37
| Facility | | $4,073.80 | $14,125.38 | $32,359.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,344.23 / $3,311.31 / $7,943.28
| Facility | | $2,344.23 | $3,311.31 | $7,943.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,570.40 / $3,162.28 / $6,309.57
| Facility | | $2,570.40 | $3,162.28 | $6,309.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $741.31 / $1,412.54 / $2,630.27
| Facility | | $741.31 | $1,412.54 | $2,630.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,754.23 / $5,888.44 / $9,332.54
| Facility | | $2,754.23 | $5,888.44 | $9,332.54 |