- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $912.01 / $3,090.30 / $7,762.47
| Facility | | $912.01 | $3,090.30 | $7,762.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,073.80 / $7,762.47 / $13,803.84
| Facility | | $4,073.80 | $7,762.47 | $13,803.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $912.01 / $1,258.93 / $4,073.80
| Facility | | $912.01 | $1,258.93 | $4,073.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,096.48 / $1,318.26 / $50,118.72
| Facility | | $1,096.48 | $1,318.26 | $50,118.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $676.08 / $1,071.52 / $2,238.72
| Facility | | $676.08 | $1,071.52 | $2,238.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $707.95 / $50,118.72 / $75,857.76
| Facility | | $707.95 | $50,118.72 | $75,857.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,511.89 / $6,456.54 / $16,595.87
| Facility | | $2,511.89 | $6,456.54 | $16,595.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $524.81 / $831.76 / $2,238.72
| Facility | | $524.81 | $831.76 | $2,238.72 |