- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $707.95 / $2,398.83 / $6,606.93
| Facility | | $707.95 | $2,398.83 | $6,606.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,548.13 / $5,623.41 / $9,120.11
| Facility | | $3,548.13 | $5,623.41 | $9,120.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,479.11 / $1,479.11 / $1,479.11
| Facility | | $1,479.11 | $1,479.11 | $1,479.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $467.74 / $891.25 / $4,265.80
| Facility | | $467.74 | $891.25 | $4,265.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $891.25 / $3,235.94 / $5,754.40
| Facility | | $891.25 | $3,235.94 | $5,754.40 |