- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $575.44 / $2,290.87 / $4,073.80
| Facility | | $575.44 | $2,290.87 | $4,073.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,258.93 / $2,187.76 / $2,951.21
| Facility | | $1,258.93 | $2,187.76 | $2,951.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $30.20 / $30.20 / $30.20
| Facility | | $30.20 | $30.20 | $30.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,786.30 / $4,786.30 / $19,498.45
| Facility | | $4,786.30 | $4,786.30 | $19,498.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,148.15 / $2,238.72 / $4,073.80
| Facility | | $1,148.15 | $2,238.72 | $4,073.80 |