- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $709.01 / $709.01 / $709.01
| Facility | | $709.01 | $709.01 | $709.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,076.76 / $6,030.62 / $11,784.35
| Facility | | $3,076.76 | $6,030.62 | $11,784.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,692.95 / $2,400.81 / $5,775.48
| Facility | | $1,692.95 | $2,400.81 | $5,775.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,376.25 / $2,194.92 / $4,547.63
| Facility | | $1,376.25 | $2,194.92 | $4,547.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $890.79 / $1,311.14 / $9,370.00
| Facility | | $890.79 | $1,311.14 | $9,370.00 |
- 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 |