- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $863.62 / $863.62 / $7,763.36
| Facility | | $863.62 | $863.62 | $7,763.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,177.42 / $7,258.38 / $14,835.02
| Facility | | $4,177.42 | $7,258.38 | $14,835.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,014.27 / $3,143.75 / $7,562.72
| Facility | | $2,014.27 | $3,143.75 | $7,562.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,745.54 / $2,868.88 / $5,954.90
| Facility | | $1,745.54 | $2,868.88 | $5,954.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $933.64 / $1,717.00 / $5,028.00
| Facility | | $933.64 | $1,717.00 | $5,028.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,201.00 / $11,496.00 / $21,528.00
| Facility | | $4,201.00 | $11,496.00 | $21,528.00 |