- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $436.52 / $1,513.56 / $5,495.41
| Facility | | $436.52 | $1,513.56 | $5,495.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,659.59 / $2,884.03 / $5,495.41
| Facility | | $1,659.59 | $2,884.03 | $5,495.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $204.17 / $269.15 / $354.81
| Facility | | $204.17 | $269.15 | $354.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $398.11 / $398.11 / $1,659.59
| Facility | | $398.11 | $398.11 | $1,659.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $524.81 / $1,348.96 / $5,248.07
| Facility | | $524.81 | $1,348.96 | $5,248.07 |