- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $842.56 / $842.56 / $842.56
| Facility | | $842.56 | $842.56 | $842.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,795.17 / $6,432.58 / $12,629.62
| Facility | | $3,795.17 | $6,432.58 | $12,629.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,087.96 / $2,961.00 / $7,123.10
| Facility | | $2,087.96 | $2,961.00 | $7,123.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,697.37 / $2,707.07 / $5,608.74
| Facility | | $1,697.37 | $2,707.07 | $5,608.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,004.29 / $1,617.74 / $3,378.00
| Facility | | $1,004.29 | $1,617.74 | $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 |