- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $912.01 / $912.01 / $2,630.27
| Facility | | $912.01 | $912.01 | $2,630.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,128.61 / $12,302.69 / $26,915.35
| Facility | | $5,128.61 | $12,302.69 | $26,915.35 |
- 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
- $912.01 / $1,862.09 / $8,317.64
| Facility | | $912.01 | $1,862.09 | $8,317.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,884.03 / $5,248.07 / $14,791.08
| Facility | | $2,884.03 | $5,248.07 | $14,791.08 |