- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $537.03 / $2,511.89 / $6,918.31
| Facility | | $537.03 | $2,511.89 | $6,918.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,258.93 / $2,454.71 / $4,677.35
| Facility | | $1,258.93 | $2,454.71 | $4,677.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $91.20 / $91.20 / $269.15
| Facility | | $91.20 | $91.20 | $269.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $173.78 / $1,047.13 / $1,445.44
| Facility | | $173.78 | $1,047.13 | $1,445.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,897.79 / $19,498.45 / $19,498.45
| Facility | | $4,897.79 | $19,498.45 | $19,498.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $104.71 / $275.42 / $676.08
| Facility | | $104.71 | $275.42 | $676.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $107.15 / $263.03 / $501.19
| Facility | | $107.15 | $263.03 | $501.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $676.08 / $2,511.89 / $4,786.30
| Facility | | $676.08 | $2,511.89 | $4,786.30 |