- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $363.08 / $457.09 / $457.09
| Facility | | $363.08 | $457.09 | $457.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,019.95 / $9,772.37 / $23,442.29
| Facility | | $3,019.95 | $9,772.37 | $23,442.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,230.27 / $1,737.80 / $4,168.69
| Facility | | $1,230.27 | $1,737.80 | $4,168.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,348.96 / $1,659.59 / $3,235.94
| Facility | | $1,348.96 | $1,659.59 | $3,235.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $524.81 / $794.33 / $7,762.47
| Facility | | $524.81 | $794.33 | $7,762.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,884.03 / $5,248.07 / $13,489.63
| Facility | | $2,884.03 | $5,248.07 | $13,489.63 |