- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $575.44 / $1,513.56 / $4,365.16
| Facility | | $575.44 | $1,513.56 | $4,365.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $588.84 / $1,412.54 / $3,235.94
| Facility | | $588.84 | $1,412.54 | $3,235.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $39.81 / $588.84 / $588.84
| Facility | | $39.81 | $588.84 | $588.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $724.44 / $724.44 / $724.44
| Facility | | $724.44 | $724.44 | $724.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $213.80 / $660.69 / $2,398.83
| Facility | | $213.80 | $660.69 | $2,398.83 |