- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $575.44 / $2,454.71 / $6,918.31
| Facility | | $575.44 | $2,454.71 | $6,918.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $851.14 / $1,621.81 / $3,235.94
| Facility | | $851.14 | $1,621.81 | $3,235.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $93.33 / $95.50 / $302.00
| Facility | | $93.33 | $95.50 | $302.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $177.83 / $831.76 / $1,071.52
| Facility | | $177.83 | $831.76 | $1,071.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,630.78 / $19,498.45 / $19,498.45
| Facility | | $3,630.78 | $19,498.45 | $19,498.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $107.15 / $288.40 / $691.83
| Facility | | $107.15 | $288.40 | $691.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $107.15 / $275.42 / $501.19
| Facility | | $107.15 | $275.42 | $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 |