- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $543.13 / $543.13 / $9,214.90
| Facility | | $543.13 | $543.13 | $9,214.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,594.03 / $5,396.85 / $11,503.06
| Facility | | $2,594.03 | $5,396.85 | $11,503.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,328.41 / $1,884.82 / $4,534.18
| Facility | | $1,328.41 | $1,884.82 | $4,534.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,207.64 / $1,723.18 / $3,570.23
| Facility | | $1,207.64 | $1,723.18 | $3,570.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $543.13 / $952.79 / $3,991.00
| Facility | | $543.13 | $952.79 | $3,991.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,121.00 / $5,499.00 / $9,810.00
| Facility | | $3,121.00 | $5,499.00 | $9,810.00 |