- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $603.03 / $3,794.17 / $6,953.60
| Facility | | $603.03 | $3,794.17 | $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
- $603.04 / $764.65 / $1,318.97
| Facility | | $603.04 | $764.65 | $1,318.97 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,064.00 / $3,456.00 / $5,919.00
| Facility | | $1,064.00 | $3,456.00 | $5,919.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,229.00 / $8,957.00 / $26,542.00
| Facility | | $2,229.00 | $8,957.00 | $26,542.00 |