- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $964.21 / $964.21 / $964.21
| Facility | | $964.21 | $964.21 | $964.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,991.74 / $9,493.79 / $21,331.89
| Facility | | $4,991.74 | $9,493.79 | $21,331.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,247.69 / $3,508.06 / $8,439.10
| Facility | | $2,247.69 | $3,508.06 | $8,439.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,947.82 / $3,201.33 / $6,644.96
| Facility | | $1,947.82 | $3,201.33 | $6,644.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,018.81 / $1,721.18 / $3,059.87
| Facility | | $1,018.81 | $1,721.18 | $3,059.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $796.00 / $3,500.00 / $8,152.00
| Facility | | $796.00 | $3,500.00 | $8,152.00 |