- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $707.95 / $3,162.28 / $6,918.31
| Facility | | $707.95 | $3,162.28 | $6,918.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,202.26 / $2,454.71 / $4,677.35
| Facility | | $1,202.26 | $2,454.71 | $4,677.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $125.89 / $1,445.44 / $1,445.44
| Facility | | $125.89 | $1,445.44 | $1,445.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $239.88 / $1,148.15 / $1,445.44
| Facility | | $239.88 | $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
- $138.04 / $204.17 / $1,862.09
| Facility | | $138.04 | $204.17 | $1,862.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $138.04 / $194.98 / $346.74
| Facility | | $138.04 | $194.98 | $346.74 |
- 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 |