- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $963.22 / $963.22 / $963.22
| Facility | | $963.22 | $963.22 | $963.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,184.29 / $6,821.74 / $13,020.23
| Facility | | $4,184.29 | $6,821.74 | $13,020.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,378.55 / $3,373.08 / $8,114.41
| Facility | | $2,378.55 | $3,373.08 | $8,114.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,933.59 / $3,083.81 / $6,389.30
| Facility | | $1,933.59 | $3,083.81 | $6,389.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,219.54 / $1,751.00 / $3,455.00
| Facility | | $1,219.54 | $1,751.00 | $3,455.00 |
- 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 |