- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $850.91 / $850.91 / $850.91
| Facility | | $850.91 | $850.91 | $850.91 |
- 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
- $1,981.00 / $2,809.31 / $6,758.18
| Facility | | $1,981.00 | $2,809.31 | $6,758.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,610.41 / $2,568.38 / $5,321.40
| Facility | | $1,610.41 | $2,568.38 | $5,321.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,110.71 / $1,646.92 / $3,500.00
| Facility | | $1,110.71 | $1,646.92 | $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 |