- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $776.25 / $776.25 / $2,630.27
| Facility | | $776.25 | $776.25 | $2,630.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,786.30 / $11,748.98 / $26,915.35
| Facility | | $4,786.30 | $11,748.98 | $26,915.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,862.09 / $2,951.21 / $7,079.46
| Facility | | $1,862.09 | $2,951.21 | $7,079.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,290.87 / $2,818.38 / $5,495.41
| Facility | | $2,290.87 | $2,818.38 | $5,495.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $776.25 / $1,258.93 / $2,398.83
| Facility | | $776.25 | $1,258.93 | $2,398.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,659.59 / $4,786.30 / $9,332.54
| Facility | | $1,659.59 | $4,786.30 | $9,332.54 |