- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $901.31 / $901.31 / $901.31
| Facility | | $901.31 | $901.31 | $901.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,582.97 / $11,589.55 / $23,673.40
| Facility | | $4,582.97 | $11,589.55 | $23,673.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,269.06 / $3,217.81 / $7,740.87
| Facility | | $2,269.06 | $3,217.81 | $7,740.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,844.58 / $2,941.85 / $6,095.18
| Facility | | $1,844.58 | $2,941.85 | $6,095.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,145.45 / $1,751.00 / $3,378.00
| Facility | | $1,145.45 | $1,751.00 | $3,378.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,445.00 / $3,236.00 / $5,530.00
| Facility | | $1,445.00 | $3,236.00 | $5,530.00 |