- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $912.01 / $2,754.23 / $6,606.93
| Facility | | $912.01 | $2,754.23 | $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
- $389.05 / $891.25 / $5,495.41
| Facility | | $389.05 | $891.25 | $5,495.41 |
- 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 |