- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $893.05 / $893.05 / $893.05
| Facility | | $893.05 | $893.05 | $893.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,045.81 / $6,373.77 / $12,643.17
| Facility | | $4,045.81 | $6,373.77 | $12,643.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,371.82 / $3,363.53 / $8,091.42
| Facility | | $2,371.82 | $3,363.53 | $8,091.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,928.12 / $3,075.07 / $6,371.20
| Facility | | $1,928.12 | $3,075.07 | $6,371.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,283.70 / $1,955.73 / $5,499.00
| Facility | | $1,283.70 | $1,955.73 | $5,499.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,293.00 / $6,652.00 / $9,810.00
| Facility | | $3,293.00 | $6,652.00 | $9,810.00 |