- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $691.83 / $870.96 / $3,630.78
| Facility | | $691.83 | $870.96 | $3,630.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,884.03 / $4,677.35 / $13,182.57
| Facility | | $2,884.03 | $4,677.35 | $13,182.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,344.23 / $3,311.31 / $7,943.28
| Facility | | $2,344.23 | $3,311.31 | $7,943.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,570.40 / $3,162.28 / $6,165.95
| Facility | | $2,570.40 | $3,162.28 | $6,165.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $758.58 / $1,288.25 / $2,691.53
| Facility | | $758.58 | $1,288.25 | $2,691.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,691.53 / $4,265.80 / $6,760.83
| Facility | | $2,691.53 | $4,265.80 | $6,760.83 |