- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $776.25 / $1,258.93 / $1,819.70
| Facility | | $776.25 | $1,258.93 | $1,819.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $251.19 / $4,677.35 / $4,677.35
| Facility | | $251.19 | $4,677.35 | $4,677.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,235.94 / $3,235.94 / $5,754.40
| Facility | | $3,235.94 | $3,235.94 | $5,754.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $776.25 / $1,513.56 / $1,819.70
| Facility | | $776.25 | $1,513.56 | $1,819.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,235.94 / $3,235.94 / $5,754.40
| Facility | | $3,235.94 | $3,235.94 | $5,754.40 |