- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $974.23 / $974.23 / $974.23
| Facility | | $974.23 | $974.23 | $974.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,560.54 / $9,560.76 / $20,316.56
| Facility | | $4,560.54 | $9,560.76 | $20,316.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,154.51 / $3,055.36 / $7,350.09
| Facility | | $2,154.51 | $3,055.36 | $7,350.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,751.46 / $2,793.34 / $5,787.48
| Facility | | $1,751.46 | $2,793.34 | $5,787.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,384.54 / $1,987.80 / $12,367.00
| Facility | | $1,384.54 | $1,987.80 | $12,367.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,913.00 / $12,722.00 / $17,883.81
| Facility | | $5,913.00 | $12,722.00 | $17,883.81 |