- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $933.25 / $2,630.27 / $5,888.44
| Facility | | $933.25 | $2,630.27 | $5,888.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,905.46 / $4,073.80 / $6,456.54
| Facility | | $1,905.46 | $4,073.80 | $6,456.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $39.81 / $39.81 / $39.81
| Facility | | $39.81 | $39.81 | $39.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $851.14 / $851.14 / $851.14
| Facility | | $851.14 | $851.14 | $851.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $831.76 / $2,630.27 / $6,165.95
| Facility | | $831.76 | $2,630.27 | $6,165.95 |