- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $588.84 / $2,951.21 / $6,760.83
| Facility | | $588.84 | $2,951.21 | $6,760.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,365.16 / $6,760.83 / $11,220.18
| Facility | | $4,365.16 | $6,760.83 | $11,220.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,570.40 / $2,570.40 / $2,570.40
| Facility | | $2,570.40 | $2,570.40 | $2,570.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $446.68 / $758.58 / $5,495.41
| Facility | | $446.68 | $758.58 | $5,495.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $891.25 / $3,235.94 / $6,025.60
| Facility | | $891.25 | $3,235.94 | $6,025.60 |