- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $707.95 / $2,951.21 / $6,918.31
| Facility | | $707.95 | $2,951.21 | $6,918.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,258.93 / $2,570.40 / $4,897.79
| Facility | | $1,258.93 | $2,570.40 | $4,897.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $112.20 / $112.20 / $263.03
| Facility | | $112.20 | $112.20 | $263.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,623.41 / $28,840.32 / $28,840.32
| Facility | | $5,623.41 | $28,840.32 | $28,840.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $117.49 / $331.13 / $4,265.80
| Facility | | $117.49 | $331.13 | $4,265.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $112.20 / $229.09 / $371.54
| Facility | | $112.20 | $229.09 | $371.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $724.44 / $2,511.89 / $4,786.30
| Facility | | $724.44 | $2,511.89 | $4,786.30 |