- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $891.25 / $891.25 / $6,760.83
| Facility | | $891.25 | $891.25 | $6,760.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,011.87 / $9,549.93 / $18,620.87
| Facility | | $5,011.87 | $9,549.93 | $18,620.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,187.76 / $3,090.30 / $7,413.10
| Facility | | $2,187.76 | $3,090.30 | $7,413.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,398.83 / $2,951.21 / $5,754.40
| Facility | | $2,398.83 | $2,951.21 | $5,754.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $912.01 / $1,584.89 / $9,772.37
| Facility | | $912.01 | $1,584.89 | $9,772.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,311.31 / $8,709.64 / $11,748.98
| Facility | | $3,311.31 | $8,709.64 | $11,748.98 |