- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $295.12 / $2,818.38 / $5,011.87
| Facility | | $295.12 | $2,818.38 | $5,011.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $645.65 / $5,011.87 / $28,840.32
| Facility | | $645.65 | $5,011.87 | $28,840.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $316.23 / $316.23 / $724.44
| Facility | | $316.23 | $316.23 | $724.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $263.03 / $562.34 / $7,079.46
| Facility | | $263.03 | $562.34 | $7,079.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,995.26 / $4,265.80 / $9,772.37
| Facility | | $1,995.26 | $4,265.80 | $9,772.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,951.21 / $2,951.21 / $6,165.95
| Facility | | $2,951.21 | $2,951.21 | $6,165.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $645.65 / $5,011.87 / $28,840.32
| Facility | | $645.65 | $5,011.87 | $28,840.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,862.09 / $4,265.80 / $9,549.93
| Facility | | $1,862.09 | $4,265.80 | $9,549.93 |