- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $963.15 / $963.15 / $963.15
| Facility | | $963.15 | $963.15 | $963.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,866.71 / $11,589.55 / $23,673.40
| Facility | | $4,866.71 | $11,589.55 | $23,673.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,376.87 / $3,370.70 / $8,108.66
| Facility | | $2,376.87 | $3,370.70 | $8,108.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,932.22 / $3,081.62 / $6,384.78
| Facility | | $1,932.22 | $3,081.62 | $6,384.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,222.44 / $1,751.00 / $3,378.00
| Facility | | $1,222.44 | $1,751.00 | $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 |