- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $223.87 / $3,548.13 / $3,548.13
| Facility | | $223.87 | $3,548.13 | $3,548.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $234.42 / $234.42 / $288.40
| Facility | | $234.42 | $234.42 | $288.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $380.19 / $380.19 / $380.19
| Facility | | $380.19 | $380.19 | $380.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,760.83 / $6,760.83 / $6,760.83
| Facility | | $6,760.83 | $6,760.83 | $6,760.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,230.27 / $1,230.27 / $3,311.31
| Facility | | $1,230.27 | $1,230.27 | $3,311.31 |