- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $741.31 / $741.31 / $741.31
| Facility | | $741.31 | $741.31 | $741.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12.02 / $16.98 / $32.36
| Facility | | $12.02 | $16.98 | $32.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $537.03 / $912.01 / $1,071.52
| Facility | | $537.03 | $912.01 | $1,071.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $741.31 / $741.31 / $741.31
| Facility | | $741.31 | $741.31 | $741.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $537.03 / $537.03 / $1,071.52
| Facility | | $537.03 | $537.03 | $1,071.52 |