- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $856.44 / $856.44 / $856.44
| Facility | | $856.44 | $856.44 | $856.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,677.15 / $5,792.97 / $11,491.08
| Facility | | $3,677.15 | $5,792.97 | $11,491.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,996.17 / $2,830.81 / $6,809.90
| Facility | | $1,996.17 | $2,830.81 | $6,809.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,622.74 / $2,588.04 / $5,362.13
| Facility | | $1,622.74 | $2,588.04 | $5,362.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,053.93 / $1,547.32 / $3,378.00
| Facility | | $1,053.93 | $1,547.32 | $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 |