- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $380.19 / $6,760.83 / $6,760.83
| Facility | | $380.19 | $6,760.83 | $6,760.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $416.87 / $416.87 / $501.19
| Facility | | $416.87 | $416.87 | $501.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $676.08 / $676.08 / $2,290.87
| Facility | | $676.08 | $676.08 | $2,290.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,548.13 / $3,548.13 / $5,754.40
| Facility | | $3,548.13 | $3,548.13 | $5,754.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,454.71 / $2,454.71 / $4,466.84
| Facility | | $2,454.71 | $2,454.71 | $4,466.84 |