- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $910.39 / $910.39 / $910.39
| Facility | | $910.39 | $910.39 | $910.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,692.86 / $6,020.57 / $11,491.08
| Facility | | $3,692.86 | $6,020.57 | $11,491.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,116.61 / $3,001.62 / $7,220.79
| Facility | | $2,116.61 | $3,001.62 | $7,220.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,720.65 / $2,744.20 / $5,685.66
| Facility | | $1,720.65 | $2,744.20 | $5,685.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,187.07 / $1,760.14 / $3,500.00
| Facility | | $1,187.07 | $1,760.14 | $3,500.00 |
- 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 |