- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $944.40 / $944.40 / $944.40
| Facility | | $944.40 | $944.40 | $944.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,748.94 / $11,203.41 / $22,223.37
| Facility | | $6,748.94 | $11,203.41 | $22,223.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,093.87 / $2,969.37 / $7,143.21
| Facility | | $2,093.87 | $2,969.37 | $7,143.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,702.16 / $2,714.71 / $5,624.58
| Facility | | $1,702.16 | $2,714.71 | $5,624.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,357.31 / $1,935.94 / $12,367.00
| Facility | | $1,357.31 | $1,935.94 | $12,367.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,577.00 / $10,743.00 / $12,774.00
| Facility | | $5,577.00 | $10,743.00 | $12,774.00 |