- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $707.95 / $2,398.83 / $6,456.54
| Facility | | $707.95 | $2,398.83 | $6,456.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,258.93 / $2,238.72 / $3,019.95
| Facility | | $1,258.93 | $2,238.72 | $3,019.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $794.33 / $794.33 / $794.33
| Facility | | $794.33 | $794.33 | $794.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $54.95 / $3,715.35 / $3,715.35
| Facility | | $54.95 | $3,715.35 | $3,715.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,041.74 / $3,630.78 / $6,309.57
| Facility | | $2,041.74 | $3,630.78 | $6,309.57 |