- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $933.86 / $933.86 / $8,331.90
| Facility | | $933.86 | $933.86 | $8,331.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,709.60 / $16,192.78 / $36,581.76
| Facility | | $4,709.60 | $16,192.78 | $36,581.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,418.98 / $3,430.42 / $8,252.33
| Facility | | $2,418.98 | $3,430.42 | $8,252.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,966.46 / $3,136.22 / $6,497.90
| Facility | | $1,966.46 | $3,136.22 | $6,497.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,481.61 / $2,055.64 / $12,051.00
| Facility | | $1,481.61 | $2,055.64 | $12,051.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,577.00 / $10,743.00 / $12,774.00
| Facility | | $5,577.00 | $10,743.00 | $12,774.00 |