- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $234.42 / $1,230.27 / $1,230.27
| Facility | | $234.42 | $1,230.27 | $1,230.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,548.82 / $3,801.89 / $8,709.64
| Facility | | $1,548.82 | $3,801.89 | $8,709.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,818.38 / $4,570.88 / $10,964.78
| Facility | | $2,818.38 | $4,570.88 | $10,964.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,548.13 / $4,265.80 / $8,709.64
| Facility | | $3,548.13 | $4,265.80 | $8,709.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $275.42 / $1,148.15 / $3,388.44
| Facility | | $275.42 | $1,148.15 | $3,388.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,230.27 / $3,467.37 / $6,760.83
| Facility | | $1,230.27 | $3,467.37 | $6,760.83 |