- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $791.20 / $791.20 / $791.20
| Facility | | $791.20 | $791.20 | $791.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,512.22 / $5,792.97 / $11,146.35
| Facility | | $3,512.22 | $5,792.97 | $11,146.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,849.61 / $2,622.98 / $6,309.93
| Facility | | $1,849.61 | $2,622.98 | $6,309.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,503.60 / $2,398.03 / $4,968.45
| Facility | | $1,503.60 | $2,398.03 | $4,968.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,183.45 / $1,434.48 / $3,378.00
| Facility | | $1,183.45 | $1,434.48 | $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 |