- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $489.78 / $3,630.78 / $8,128.31
| Facility | | $489.78 | $3,630.78 | $8,128.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $645.65 / $645.65 / $645.65
| Facility | | $645.65 | $645.65 | $645.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $602.56 / $602.56 / $1,258.93
| Facility | | $602.56 | $602.56 | $1,258.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $199.53 / $281.84 / $3,311.31
| Facility | | $199.53 | $281.84 | $3,311.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $831.76 / $1,202.26 / $3,311.31
| Facility | | $831.76 | $1,202.26 | $3,311.31 |