- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $870.96 / $870.96 / $2,630.27
| Facility | | $870.96 | $870.96 | $2,630.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,187.76 / $7,079.46 / $16,595.87
| Facility | | $2,187.76 | $7,079.46 | $16,595.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,344.23 / $3,388.44 / $7,943.28
| Facility | | $2,344.23 | $3,388.44 | $7,943.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,570.40 / $3,235.94 / $6,309.57
| Facility | | $2,570.40 | $3,235.94 | $6,309.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $954.99 / $1,548.82 / $8,912.51
| Facility | | $954.99 | $1,548.82 | $8,912.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,019.95 / $6,025.60 / $10,715.19
| Facility | | $3,019.95 | $6,025.60 | $10,715.19 |