- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $976.22 / $976.22 / $18,681.64
| Facility | | $976.22 | $976.22 | $18,681.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,178.08 / $3,144.69 / $8,364.45
| Facility | | $1,178.08 | $3,144.69 | $8,364.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,263.76 / $3,533.14 / $8,499.44
| Facility | | $2,263.76 | $3,533.14 | $8,499.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,961.75 / $3,224.22 / $6,692.48
| Facility | | $1,961.75 | $3,224.22 | $6,692.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,084.92 / $2,021.25 / $5,913.00
| Facility | | $1,084.92 | $2,021.25 | $5,913.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,437.00 / $9,370.00 / $12,774.00
| Facility | | $3,437.00 | $9,370.00 | $12,774.00 |