- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $707.95 / $2,884.03 / $6,918.31
| Facility | | $707.95 | $2,884.03 | $6,918.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,801.89 / $7,585.78 / $14,791.08
| Facility | | $3,801.89 | $7,585.78 | $14,791.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $323.59 / $724.44 / $724.44
| Facility | | $323.59 | $724.44 | $724.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $616.60 / $3,162.28 / $4,168.69
| Facility | | $616.60 | $3,162.28 | $4,168.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,595.87 / $28,840.32 / $28,840.32
| Facility | | $16,595.87 | $28,840.32 | $28,840.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $363.08 / $537.03 / $1,122.02
| Facility | | $363.08 | $537.03 | $1,122.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $363.08 / $524.81 / $933.25
| Facility | | $363.08 | $524.81 | $933.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,380.38 / $3,981.07 / $8,912.51
| Facility | | $1,380.38 | $3,981.07 | $8,912.51 |