- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $776.25 / $3,162.28 / $7,943.28
| Facility | | $776.25 | $3,162.28 | $7,943.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,174.90 / $2,454.71 / $4,677.35
| Facility | | $1,174.90 | $2,454.71 | $4,677.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $204.17 / $204.17 / $218.78
| Facility | | $204.17 | $204.17 | $218.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $398.11 / $1,148.15 / $1,445.44
| Facility | | $398.11 | $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
- $229.09 / $346.74 / $1,513.56
| Facility | | $229.09 | $346.74 | $1,513.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $229.09 / $323.59 / $575.44
| Facility | | $229.09 | $323.59 | $575.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $724.44 / $2,511.89 / $4,786.30
| Facility | | $724.44 | $2,511.89 | $4,786.30 |