- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $762.88 / $762.88 / $762.88
| Facility | | $762.88 | $762.88 | $762.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,505.60 / $6,498.38 / $12,890.36
| Facility | | $3,505.60 | $6,498.38 | $12,890.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,701.37 / $2,412.76 / $5,804.22
| Facility | | $1,701.37 | $2,412.76 | $5,804.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,383.09 / $2,205.84 / $4,570.25
| Facility | | $1,383.09 | $2,205.84 | $4,570.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $932.48 / $1,478.06 / $5,787.00
| Facility | | $932.48 | $1,478.06 | $5,787.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,755.00 / $2,872.00 / $4,241.00
| Facility | | $1,755.00 | $2,872.00 | $4,241.00 |