- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $794.33 / $794.33 / $794.33
| Facility | | $794.33 | $794.33 | $794.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,370.32 / $12,882.50 / $26,302.68
| Facility | | $5,370.32 | $12,882.50 | $26,302.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,949.84 / $3,090.30 / $7,413.10
| Facility | | $1,949.84 | $3,090.30 | $7,413.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,398.83 / $2,951.21 / $5,754.40
| Facility | | $2,398.83 | $2,951.21 | $5,754.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $794.33 / $1,288.25 / $2,570.40
| Facility | | $794.33 | $1,288.25 | $2,570.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $794.33 / $3,311.31 / $8,511.38
| Facility | | $794.33 | $3,311.31 | $8,511.38 |