- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $660.69 / $1,513.56 / $4,168.69
| Facility | | $660.69 | $1,513.56 | $4,168.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,495.41 / $9,332.54 / $13,489.63
| Facility | | $5,495.41 | $9,332.54 | $13,489.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $39.81 / $39.81 / $602.56
| Facility | | $39.81 | $39.81 | $602.56 |
- 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
- $1,202.26 / $6,456.54 / $13,489.63
| Facility | | $1,202.26 | $6,456.54 | $13,489.63 |