- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $758.58 / $758.58 / $3,630.78
| Facility | | $758.58 | $758.58 | $3,630.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,511.89 / $5,623.41 / $12,022.64
| Facility | | $2,511.89 | $5,623.41 | $12,022.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,949.84 / $2,754.23 / $6,606.93
| Facility | | $1,949.84 | $2,754.23 | $6,606.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,137.96 / $2,630.27 / $5,248.07
| Facility | | $2,137.96 | $2,630.27 | $5,248.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $794.33 / $1,479.11 / $5,011.87
| Facility | | $794.33 | $1,479.11 | $5,011.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,398.83 / $4,168.69 / $8,912.51
| Facility | | $2,398.83 | $4,168.69 | $8,912.51 |