- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $831.76 / $10,471.29 / $18,197.01
| Facility | | $831.76 | $10,471.29 | $18,197.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,630.27 / $5,495.41 / $10,232.93
| Facility | | $2,630.27 | $5,495.41 | $10,232.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $707.95 / $707.95 / $707.95
| Facility | | $707.95 | $707.95 | $707.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $229.09 / $323.59 / $707.95
| Facility | | $229.09 | $323.59 | $707.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $354.81 / $1,202.26 / $3,548.13
| Facility | | $354.81 | $1,202.26 | $3,548.13 |