- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $736.14 / $736.14 / $736.14
| Facility | | $736.14 | $736.14 | $736.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $314.92 / $664.32 / $5,952.82
| Facility | | $314.92 | $664.32 | $5,952.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,953.21 / $2,769.89 / $6,663.36
| Facility | | $1,953.21 | $2,769.89 | $6,663.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,587.82 / $2,532.35 / $5,246.74
| Facility | | $1,587.82 | $2,532.35 | $5,246.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,035.59 / $1,608.48 / $4,746.00
| Facility | | $1,035.59 | $1,608.48 | $4,746.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,735.00 / $4,974.00 / $8,812.00
| Facility | | $2,735.00 | $4,974.00 | $8,812.00 |