- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $776.25 / $3,019.95 / $7,413.10
| Facility | | $776.25 | $3,019.95 | $7,413.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $891.25 / $1,905.46 / $3,801.89
| Facility | | $891.25 | $1,905.46 | $3,801.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $79.43 / $199.53 / $208.93
| Facility | | $79.43 | $199.53 | $208.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,090.30 / $28,840.32 / $28,840.32
| Facility | | $3,090.30 | $28,840.32 | $28,840.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $218.78 / $363.08 / $3,715.35
| Facility | | $218.78 | $363.08 | $3,715.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $213.80 / $323.59 / $562.34
| Facility | | $213.80 | $323.59 | $562.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $158.49 / $1,047.13 / $2,691.53
| Facility | | $158.49 | $1,047.13 | $2,691.53 |