- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $616.60 / $2,290.87 / $4,073.80
| Facility | | $616.60 | $2,290.87 | $4,073.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,737.80 / $5,888.44 / $9,772.37
| Facility | | $1,737.80 | $5,888.44 | $9,772.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $323.59 / $1,348.96 / $6,606.93
| Facility | | $323.59 | $1,348.96 | $6,606.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $54.95 / $56.23 / $22,908.68
| Facility | | $54.95 | $56.23 | $22,908.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,737.80 / $4,466.84 / $7,585.78
| Facility | | $1,737.80 | $4,466.84 | $7,585.78 |