- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $458.61 / $777.09 / $1,400.00
| Facility | | $458.61 | $777.09 | $1,400.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $544.71 / $601.79 / $655.67
| Facility | | $544.71 | $601.79 | $655.67 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $588.11 / $588.11 / $588.11
| Facility | | $588.11 | $588.11 | $588.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,883.55 / $4,883.55 / $4,883.55
| Facility | | $4,883.55 | $4,883.55 | $4,883.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,474.93 / $5,474.93 / $5,474.93
| Facility | | $5,474.93 | $5,474.93 | $5,474.93 |