- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $724.44 / $724.44 / $2,238.72
| Facility | | $724.44 | $724.44 | $2,238.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,162.28 / $7,413.10 / $14,791.08
| Facility | | $3,162.28 | $7,413.10 | $14,791.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,819.70 / $2,570.40 / $6,165.95
| Facility | | $1,819.70 | $2,570.40 | $6,165.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,995.26 / $2,454.71 / $4,897.79
| Facility | | $1,995.26 | $2,454.71 | $4,897.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $630.96 / $1,202.26 / $6,760.83
| Facility | | $630.96 | $1,202.26 | $6,760.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,398.83 / $4,786.30 / $8,912.51
| Facility | | $2,398.83 | $4,786.30 | $8,912.51 |