- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $398.11 / $398.11 / $2,630.27
| Facility | | $398.11 | $398.11 | $2,630.27 |
- 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
- $1,023.29 / $1,445.44 / $3,467.37
| Facility | | $1,023.29 | $1,445.44 | $3,467.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,122.02 / $1,412.54 / $2,754.23
| Facility | | $1,122.02 | $1,412.54 | $2,754.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $398.11 / $758.58 / $4,786.30
| Facility | | $398.11 | $758.58 | $4,786.30 |
- 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 |