- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $960.23 / $960.23 / $960.23
| Facility | | $960.23 | $960.23 | $960.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,440.31 / $9,944.10 / $20,913.50
| Facility | | $4,440.31 | $9,944.10 | $20,913.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,122.51 / $3,009.98 / $7,240.91
| Facility | | $2,122.51 | $3,009.98 | $7,240.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,725.44 / $2,751.84 / $5,701.50
| Facility | | $1,725.44 | $2,751.84 | $5,701.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,430.12 / $1,752.70 / $3,500.00
| Facility | | $1,430.12 | $1,752.70 | $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 |