- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $926.20 / $926.20 / $926.20
| Facility | | $926.20 | $926.20 | $926.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $810.89 / $4,434.95 / $7,986.91
| Facility | | $810.89 | $4,434.95 | $7,986.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,155.08 / $3,363.53 / $8,091.42
| Facility | | $2,155.08 | $3,363.53 | $8,091.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,867.57 / $3,069.44 / $6,371.20
| Facility | | $1,867.57 | $3,069.44 | $6,371.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $918.32 / $1,634.92 / $2,890.30
| Facility | | $918.32 | $1,634.92 | $2,890.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $796.00 / $3,500.00 / $8,152.00
| Facility | | $796.00 | $3,500.00 | $8,152.00 |