- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $812.83 / $812.83 / $6,760.83
| Facility | | $812.83 | $812.83 | $6,760.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $131.83 / $6,025.60 / $14,454.40
| Facility | | $131.83 | $6,025.60 | $14,454.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,905.46 / $2,691.53 / $6,456.54
| Facility | | $1,905.46 | $2,691.53 | $6,456.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,089.30 / $2,630.27 / $5,128.61
| Facility | | $2,089.30 | $2,630.27 | $5,128.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $977.24 / $1,698.24 / $9,332.54
| Facility | | $977.24 | $1,698.24 | $9,332.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,265.80 / $7,079.46 / $10,715.19
| Facility | | $4,265.80 | $7,079.46 | $10,715.19 |