- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $977.24 / $977.24 / $5,011.87
| Facility | | $977.24 | $977.24 | $5,011.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,897.79 / $9,549.93 / $18,620.87
| Facility | | $4,897.79 | $9,549.93 | $18,620.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,398.83 / $3,388.44 / $8,128.31
| Facility | | $2,398.83 | $3,388.44 | $8,128.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,630.27 / $3,235.94 / $6,309.57
| Facility | | $2,630.27 | $3,235.94 | $6,309.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $933.25 / $1,621.81 / $6,760.83
| Facility | | $933.25 | $1,621.81 | $6,760.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,884.03 / $5,248.07 / $10,471.29
| Facility | | $2,884.03 | $5,248.07 | $10,471.29 |