- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $645.65 / $2,570.40 / $5,623.41
| Facility | | $645.65 | $2,570.40 | $5,623.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $416.87 / $1,096.48 / $1,995.26
| Facility | | $416.87 | $1,096.48 | $1,995.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $416.87 / $549.54 / $575.44
| Facility | | $416.87 | $549.54 | $575.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $117.49 / $169.82 / $2,398.83
| Facility | | $117.49 | $169.82 | $2,398.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $776.25 / $1,862.09 / $4,677.35
| Facility | | $776.25 | $1,862.09 | $4,677.35 |