- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $478.63 / $2,570.40 / $10,715.19
| Facility | | $478.63 | $2,570.40 | $10,715.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $954.99 / $2,511.89 / $7,943.28
| Facility | | $954.99 | $2,511.89 | $7,943.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $363.08 / $407.38 / $1,737.80
| Facility | | $363.08 | $407.38 | $1,737.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $380.19 / $660.69 / $2,137.96
| Facility | | $380.19 | $660.69 | $2,137.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $380.19 / $660.69 / $2,818.38
| Facility | | $380.19 | $660.69 | $2,818.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $100.00 / $100.00 / $4,073.80
| Facility | | $100.00 | $100.00 | $4,073.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $676.08 / $2,454.71 / $5,248.07
| Facility | | $676.08 | $2,454.71 | $5,248.07 |