- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $788.78 / $788.78 / $788.78
| Facility | | $788.78 | $788.78 | $788.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,073.22 / $9,493.79 / $20,505.30
| Facility | | $4,073.22 | $9,493.79 | $20,505.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,838.25 / $2,869.03 / $6,901.85
| Facility | | $1,838.25 | $2,869.03 | $6,901.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,593.01 / $2,618.17 / $5,434.53
| Facility | | $1,593.01 | $2,618.17 | $5,434.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $836.84 / $1,408.43 / $2,503.87
| Facility | | $836.84 | $1,408.43 | $2,503.87 |
- 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 |