- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $577.22 / $577.22 / $577.22
| Facility | | $577.22 | $577.22 | $577.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $388.77 / $815.93 / $14,172.34
| Facility | | $388.77 | $815.93 | $14,172.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,547.24 / $2,194.17 / $5,278.39
| Facility | | $1,547.24 | $2,194.17 | $5,278.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,257.79 / $2,006.00 / $4,156.21
| Facility | | $1,257.79 | $2,006.00 | $4,156.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $850.33 / $1,197.26 / $3,378.00
| Facility | | $850.33 | $1,197.26 | $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 |