- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $831.76 / $5,888.44 / $10,964.78
| Facility | | $831.76 | $5,888.44 | $10,964.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $954.99 / $3,467.37 / $15,135.61
| Facility | | $954.99 | $3,467.37 | $15,135.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $398.11 / $457.09 / $2,344.23
| Facility | | $398.11 | $457.09 | $2,344.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $34.67 / $724.44 / $3,801.89
| Facility | | $34.67 | $724.44 | $3,801.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $562.34 / $724.44 / $3,801.89
| Facility | | $562.34 | $724.44 | $3,801.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $100.00 / $100.00 / $4,677.35
| Facility | | $100.00 | $100.00 | $4,677.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $794.33 / $4,168.69 / $7,413.10
| Facility | | $794.33 | $4,168.69 | $7,413.10 |