- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $858.77 / $858.77 / $858.77
| Facility | | $858.77 | $858.77 | $858.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,536.22 / $10,188.53 / $20,811.61
| Facility | | $3,536.22 | $10,188.53 | $20,811.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,991.95 / $2,824.84 / $6,795.53
| Facility | | $1,991.95 | $2,824.84 | $6,795.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,619.32 / $2,582.58 / $5,350.81
| Facility | | $1,619.32 | $2,582.58 | $5,350.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,033.55 / $1,562.97 / $7,770.00
| Facility | | $1,033.55 | $1,562.97 | $7,770.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,735.00 / $4,974.00 / $8,812.00
| Facility | | $2,735.00 | $4,974.00 | $8,812.00 |