- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $687.57 / $687.57 / $687.57
| Facility | | $687.57 | $687.57 | $687.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,088.76 / $3,964.30 / $6,499.58
| Facility | | $2,088.76 | $3,964.30 | $6,499.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,655.04 / $2,348.26 / $5,649.06
| Facility | | $1,655.04 | $2,348.26 | $5,649.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,504.58 / $2,146.87 / $4,448.08
| Facility | | $1,504.58 | $2,146.87 | $4,448.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $749.91 / $1,172.60 / $2,044.96
| Facility | | $749.91 | $1,172.60 | $2,044.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,457.00 / $9,370.00 / $12,774.00
| Facility | | $5,457.00 | $9,370.00 | $12,774.00 |