- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $724.44 / $3,388.44 / $7,943.28
| Facility | | $724.44 | $3,388.44 | $7,943.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,778.28 / $3,801.89 / $8,511.38
| Facility | | $1,778.28 | $3,801.89 | $8,511.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,905.46 / $1,905.46 / $1,905.46
| Facility | | $1,905.46 | $1,905.46 | $1,905.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $489.78 / $794.33 / $1,288.25
| Facility | | $489.78 | $794.33 | $1,288.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,495.41 / $7,244.36 / $10,232.93
| Facility | | $5,495.41 | $7,244.36 | $10,232.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,348.96 / $5,495.41 / $12,302.69
| Facility | | $1,348.96 | $5,495.41 | $12,302.69 |