- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $707.95 / $3,019.95 / $7,079.46
| Facility | | $707.95 | $3,019.95 | $7,079.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,318.26 / $2,290.87 / $4,466.84
| Facility | | $1,318.26 | $2,290.87 | $4,466.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $79.43 / $87.10 / $91.20
| Facility | | $79.43 | $87.10 | $91.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,981.07 / $28,840.32 / $28,840.32
| Facility | | $3,981.07 | $28,840.32 | $28,840.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $95.50 / $229.09 / $2,454.71
| Facility | | $95.50 | $229.09 | $2,454.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $95.50 / $204.17 / $363.08
| Facility | | $95.50 | $204.17 | $363.08 |
- 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 |