- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $758.58 / $2,041.74 / $4,570.88
| Facility | | $758.58 | $2,041.74 | $4,570.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,238.72 / $4,570.88 / $6,918.31
| Facility | | $2,238.72 | $4,570.88 | $6,918.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $39.81 / $630.96 / $1,348.96
| Facility | | $39.81 | $630.96 | $1,348.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $724.44 / $954.99 / $2,041.74
| Facility | | $724.44 | $954.99 | $2,041.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $831.76 / $2,398.83 / $6,309.57
| Facility | | $831.76 | $2,398.83 | $6,309.57 |