- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $806.21 / $806.21 / $12,383.25
| Facility | | $806.21 | $806.21 | $12,383.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,509.28 / $4,717.05 / $7,808.13
| Facility | | $2,509.28 | $4,717.05 | $7,808.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,005.24 / $2,845.14 / $6,844.38
| Facility | | $2,005.24 | $2,845.14 | $6,844.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,822.94 / $2,601.14 / $5,389.28
| Facility | | $1,822.94 | $2,601.14 | $5,389.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $843.60 / $1,446.57 / $4,746.00
| Facility | | $843.60 | $1,446.57 | $4,746.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,412.00 / $4,746.00 / $8,812.00
| Facility | | $2,412.00 | $4,746.00 | $8,812.00 |