- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $851.14 / $3,019.95 / $7,943.28
| Facility | | $851.14 | $3,019.95 | $7,943.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,715.35 / $7,585.78 / $14,791.08
| Facility | | $3,715.35 | $7,585.78 | $14,791.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $707.95 / $707.95 / $758.58
| Facility | | $707.95 | $707.95 | $758.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,318.26 / $3,548.13 / $4,168.69
| Facility | | $1,318.26 | $3,548.13 | $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
- $741.31 / $1,047.13 / $2,511.89
| Facility | | $741.31 | $1,047.13 | $2,511.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $741.31 / $1,023.29 / $1,778.28
| Facility | | $741.31 | $1,023.29 | $1,778.28 |
- 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 |