- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $537.03 / $2,630.27 / $6,760.83
| Facility | | $537.03 | $2,630.27 | $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
- $5,623.41 / $5,623.41 / $5,623.41
| Facility | | $5,623.41 | $5,623.41 | $5,623.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $380.19 / $660.69 / $5,495.41
| Facility | | $380.19 | $660.69 | $5,495.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $891.25 / $3,311.31 / $6,165.95
| Facility | | $891.25 | $3,311.31 | $6,165.95 |