- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $787.75 / $787.75 / $787.75
| Facility | | $787.75 | $787.75 | $787.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,017.95 / $16,192.78 / $36,581.76
| Facility | | $4,017.95 | $16,192.78 | $36,581.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,972.58 / $2,797.37 / $6,729.44
| Facility | | $1,972.58 | $2,797.37 | $6,729.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,603.57 / $2,557.46 / $5,298.78
| Facility | | $1,603.57 | $2,557.46 | $5,298.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,075.19 / $1,407.81 / $3,378.00
| Facility | | $1,075.19 | $1,407.81 | $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 |