- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $213.80 / $371.54 / $371.54
| Facility | | $213.80 | $371.54 | $371.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,548.13 / $6,760.83 / $18,620.87
| Facility | | $3,548.13 | $6,760.83 | $18,620.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $912.01 / $1,318.26 / $3,162.28
| Facility | | $912.01 | $1,318.26 | $3,162.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,023.29 / $1,258.93 / $2,511.89
| Facility | | $1,023.29 | $1,258.93 | $2,511.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $223.87 / $457.09 / $1,819.70
| Facility | | $223.87 | $457.09 | $1,819.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,398.83 / $4,786.30 / $8,912.51
| Facility | | $2,398.83 | $4,786.30 | $8,912.51 |