- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $513.28 / $16,832.58 / $16,832.58
| Facility | | $513.28 | $16,832.58 | $16,832.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $382.55 / $421.80 / $459.55
| Facility | | $382.55 | $421.80 | $459.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $613.41 / $613.41 / $613.41
| Facility | | $613.41 | $613.41 | $613.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,610.88 / $5,610.88 / $5,610.88
| Facility | | $5,610.88 | $5,610.88 | $5,610.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,096.79 / $9,096.79 / $9,096.79
| Facility | | $9,096.79 | $9,096.79 | $9,096.79 |