- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $707.95 / $2,951.21 / $7,413.10
| Facility | | $707.95 | $2,951.21 | $7,413.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,454.71 / $4,365.16 / $8,709.64
| Facility | | $2,454.71 | $4,365.16 | $8,709.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $79.43 / $269.15 / $269.15
| Facility | | $79.43 | $269.15 | $269.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,912.51 / $28,840.32 / $28,840.32
| Facility | | $8,912.51 | $28,840.32 | $28,840.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $269.15 / $537.03 / $2,454.71
| Facility | | $269.15 | $537.03 | $2,454.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $257.04 / $478.63 / $812.83
| Facility | | $257.04 | $478.63 | $812.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,380.38 / $4,073.80 / $8,912.51
| Facility | | $1,380.38 | $4,073.80 | $8,912.51 |