- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $616.60 / $1,659.59 / $4,365.16
| Facility | | $616.60 | $1,659.59 | $4,365.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,801.89 / $6,606.93 / $11,220.18
| Facility | | $3,801.89 | $6,606.93 | $11,220.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $323.59 / $724.44 / $724.44
| Facility | | $323.59 | $724.44 | $724.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $616.60 / $724.44 / $4,265.80
| Facility | | $616.60 | $724.44 | $4,265.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $831.76 / $2,630.27 / $7,943.28
| Facility | | $831.76 | $2,630.27 | $7,943.28 |