- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $351.82 / $3,392.38 / $6,953.60
| Facility | | $351.82 | $3,392.38 | $6,953.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $606.10 / $606.10 / $2,710.28
| Facility | | $606.10 | $606.10 | $2,710.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $351.82 / $449.92 / $682.63
| Facility | | $351.82 | $449.92 | $682.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,661.00 / $7,659.00 / $10,502.00
| Facility | | $1,661.00 | $7,659.00 | $10,502.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,374.88 / $8,957.00 / $26,542.00
| Facility | | $1,374.88 | $8,957.00 | $26,542.00 |