- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $537.03 / $1,513.56 / $4,168.69
| Facility | | $537.03 | $1,513.56 | $4,168.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,412.54 / $4,466.84 / $6,456.54
| Facility | | $1,412.54 | $4,466.84 | $6,456.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $39.81 / $39.81 / $275.42
| Facility | | $39.81 | $39.81 | $275.42 |
- 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
- $831.76 / $2,630.27 / $6,606.93
| Facility | | $831.76 | $2,630.27 | $6,606.93 |