- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $870.96 / $3,630.78 / $12,022.64
| Facility | | $870.96 | $3,630.78 | $12,022.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,890.45 / $6,760.83 / $13,489.63
| Facility | | $3,890.45 | $6,760.83 | $13,489.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $302.00 / $302.00 / $302.00
| Facility | | $302.00 | $302.00 | $302.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,162.28 / $5,011.87 / $5,011.87
| Facility | | $3,162.28 | $5,011.87 | $5,011.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,589.25 / $45,708.82 / $45,708.82
| Facility | | $12,589.25 | $45,708.82 | $45,708.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $323.59 / $645.65 / $4,677.35
| Facility | | $323.59 | $645.65 | $4,677.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $309.03 / $426.58 / $741.31
| Facility | | $309.03 | $426.58 | $741.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,187.76 / $6,760.83 / $13,803.84
| Facility | | $2,187.76 | $6,760.83 | $13,803.84 |