- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $269.15 / $3,162.28 / $7,585.78
| Facility | | $269.15 | $3,162.28 | $7,585.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $575.44 / $1,071.52 / $1,202.26
| Facility | | $575.44 | $1,071.52 | $1,202.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $602.56 / $630.96 / $2,454.71
| Facility | | $602.56 | $630.96 | $2,454.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $128.82 / $204.17 / $3,311.31
| Facility | | $128.82 | $204.17 | $3,311.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $676.08 / $1,202.26 / $3,311.31
| Facility | | $676.08 | $1,202.26 | $3,311.31 |