- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $776.25 / $2,951.21 / $7,413.10
| Facility | | $776.25 | $2,951.21 | $7,413.10 |
- 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
- $134.90 / $134.90 / $141.25
| Facility | | $134.90 | $134.90 | $141.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $263.03 / $1,148.15 / $1,445.44
| Facility | | $263.03 | $1,148.15 | $1,445.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,897.79 / $28,840.32 / $28,840.32
| Facility | | $4,897.79 | $28,840.32 | $28,840.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $151.36 / $245.47 / $1,148.15
| Facility | | $151.36 | $245.47 | $1,148.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $151.36 / $239.88 / $478.63
| Facility | | $151.36 | $239.88 | $478.63 |
- 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 |