- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $748.45 / $748.45 / $748.45
| Facility | | $748.45 | $748.45 | $748.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,778.34 / $16,192.78 / $36,581.76
| Facility | | $3,778.34 | $16,192.78 | $36,581.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,870.67 / $2,652.84 / $6,381.77
| Facility | | $1,870.67 | $2,652.84 | $6,381.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,520.72 / $2,425.33 / $5,025.01
| Facility | | $1,520.72 | $2,425.33 | $5,025.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,001.45 / $1,339.62 / $3,378.00
| Facility | | $1,001.45 | $1,339.62 | $3,378.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,751.00 / $3,500.00 / $8,152.00
| Facility | | $1,751.00 | $3,500.00 | $8,152.00 |