- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $918.40 / $918.40 / $918.40
| Facility | | $918.40 | $918.40 | $918.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $0.98 / $692.83 / $3,498.78
| Facility | | $0.98 | $692.83 | $3,498.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,023.96 / $2,870.23 / $6,904.72
| Facility | | $2,023.96 | $2,870.23 | $6,904.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,645.33 / $2,624.08 / $5,436.79
| Facility | | $1,645.33 | $2,624.08 | $5,436.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,283.85 / $1,678.59 / $2,498.37
| Facility | | $1,283.85 | $1,678.59 | $2,498.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $563.00 / $1,749.00 / $2,883.00
| Facility | | $563.00 | $1,749.00 | $2,883.00 |