- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $616.60 / $616.60 / $5,011.87
| Facility | | $616.60 | $616.60 | $5,011.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,630.78 / $6,456.54 / $14,454.40
| Facility | | $3,630.78 | $6,456.54 | $14,454.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,479.11 / $2,344.23 / $5,623.41
| Facility | | $1,479.11 | $2,344.23 | $5,623.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,819.70 / $2,290.87 / $4,466.84
| Facility | | $1,819.70 | $2,290.87 | $4,466.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $616.60 / $977.24 / $1,995.26
| Facility | | $616.60 | $977.24 | $1,995.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,659.59 / $4,786.30 / $8,912.51
| Facility | | $1,659.59 | $4,786.30 | $8,912.51 |