- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $873.67 / $873.67 / $873.67
| Facility | | $873.67 | $873.67 | $873.67 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,692.86 / $5,792.97 / $11,491.08
| Facility | | $3,692.86 | $5,792.97 | $11,491.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,034.07 / $2,884.56 / $6,939.20
| Facility | | $2,034.07 | $2,884.56 | $6,939.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,653.55 / $2,637.18 / $5,463.94
| Facility | | $1,653.55 | $2,637.18 | $5,463.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,189.63 / $1,571.74 / $3,378.00
| Facility | | $1,189.63 | $1,571.74 | $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 |