- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $812.83 / $5,011.87 / $8,511.38
| Facility | | $812.83 | $5,011.87 | $8,511.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,011.87 / $6,165.95 / $57,543.99
| Facility | | $5,011.87 | $6,165.95 | $57,543.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,370.32 / $10,715.19 / $16,982.44
| Facility | | $5,370.32 | $10,715.19 | $16,982.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $812.83 / $4,168.69 / $8,511.38
| Facility | | $812.83 | $4,168.69 | $8,511.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $616.60 / $616.60 / $1,230.27
| Facility | | $616.60 | $616.60 | $1,230.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $389.05 / $489.78 / $1,122.02
| Facility | | $389.05 | $489.78 | $1,122.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,348.96 / $3,548.13 / $12,022.64
| Facility | | $1,348.96 | $3,548.13 | $12,022.64 |