- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $692.10 / $692.10 / $692.10
| Facility | | $692.10 | $692.10 | $692.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,067.75 / $6,012.96 / $11,784.35
| Facility | | $3,067.75 | $6,012.96 | $11,784.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,644.10 / $2,331.54 / $5,608.83
| Facility | | $1,644.10 | $2,331.54 | $5,608.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,336.53 / $2,131.58 / $4,416.39
| Facility | | $1,336.53 | $2,131.58 | $4,416.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $880.83 / $1,276.44 / $3,378.00
| Facility | | $880.83 | $1,276.44 | $3,378.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,445.00 / $3,236.00 / $5,530.00
| Facility | | $1,445.00 | $3,236.00 | $5,530.00 |