- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $905.72 / $905.72 / $905.72
| Facility | | $905.72 | $905.72 | $905.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,189.43 / $7,092.18 / $13,675.19
| Facility | | $4,189.43 | $7,092.18 | $13,675.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,299.38 / $3,260.81 / $7,844.31
| Facility | | $2,299.38 | $3,260.81 | $7,844.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,869.23 / $2,981.16 / $6,176.63
| Facility | | $1,869.23 | $2,981.16 | $6,176.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,238.10 / $1,643.43 / $3,378.00
| Facility | | $1,238.10 | $1,643.43 | $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 |