- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $977.24 / $977.24 / $2,238.72
| Facility | | $977.24 | $977.24 | $2,238.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $380.19 / $870.96 / $7,762.47
| Facility | | $380.19 | $870.96 | $7,762.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,511.89 / $3,548.13 / $8,317.64
| Facility | | $2,511.89 | $3,548.13 | $8,317.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,691.53 / $3,388.44 / $6,606.93
| Facility | | $2,691.53 | $3,388.44 | $6,606.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $912.01 / $1,548.82 / $2,630.27
| Facility | | $912.01 | $1,548.82 | $2,630.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $602.56 / $1,819.70 / $3,467.37
| Facility | | $602.56 | $1,819.70 | $3,467.37 |