- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $772.87 / $772.87 / $772.87
| Facility | | $772.87 | $772.87 | $772.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,987.63 / $6,952.37 / $14,584.39
| Facility | | $3,987.63 | $6,952.37 | $14,584.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,064.39 / $2,927.56 / $7,042.64
| Facility | | $2,064.39 | $2,927.56 | $7,042.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,678.20 / $2,676.49 / $5,545.39
| Facility | | $1,678.20 | $2,676.49 | $5,545.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,200.59 / $1,596.66 / $3,378.00
| Facility | | $1,200.59 | $1,596.66 | $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 |