- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $934.66 / $934.66 / $934.66
| Facility | | $934.66 | $934.66 | $934.66 |
- 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
- $2,174.73 / $3,084.03 / $7,419.05
| Facility | | $2,174.73 | $3,084.03 | $7,419.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,767.90 / $2,819.54 / $5,841.78
| Facility | | $1,767.90 | $2,819.54 | $5,841.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,153.64 / $1,805.61 / $11,496.00
| Facility | | $1,153.64 | $1,805.61 | $11,496.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,028.00 / $11,496.00 / $21,528.00
| Facility | | $5,028.00 | $11,496.00 | $21,528.00 |