- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $269.15 / $269.15 / $2,238.72
| Facility | | $269.15 | $269.15 | $2,238.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,548.82 / $4,677.35 / $10,715.19
| Facility | | $1,548.82 | $4,677.35 | $10,715.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $660.69 / $933.25 / $2,238.72
| Facility | | $660.69 | $933.25 | $2,238.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $724.44 / $891.25 / $1,737.80
| Facility | | $724.44 | $891.25 | $1,737.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $263.03 / $478.63 / $5,623.41
| Facility | | $263.03 | $478.63 | $5,623.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,884.03 / $5,248.07 / $8,912.51
| Facility | | $2,884.03 | $5,248.07 | $8,912.51 |