- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $812.83 / $3,090.30 / $5,128.61
| Facility | | $812.83 | $3,090.30 | $5,128.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,318.26 / $4,897.79 / $45,708.82
| Facility | | $1,318.26 | $4,897.79 | $45,708.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $851.14 / $851.14 / $1,949.84
| Facility | | $851.14 | $851.14 | $1,949.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $575.44 / $1,479.11 / $7,079.46
| Facility | | $575.44 | $1,479.11 | $7,079.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,995.26 / $4,265.80 / $9,772.37
| Facility | | $1,995.26 | $4,265.80 | $9,772.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,548.82 / $4,897.79 / $45,708.82
| Facility | | $1,548.82 | $4,897.79 | $45,708.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,862.09 / $4,265.80 / $12,302.69
| Facility | | $1,862.09 | $4,265.80 | $12,302.69 |