- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $428.75 / $5,423.88 / $24,000.44
| Facility | | $428.75 | $5,423.88 | $24,000.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $411.76 / $461.27 / $502.55
| Facility | | $411.76 | $461.27 | $502.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $441.79 / $441.79 / $441.79
| Facility | | $441.79 | $441.79 | $441.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,485.79 / $7,485.79 / $12,901.05
| Facility | | $7,485.79 | $7,485.79 | $12,901.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,910.00 / $2,910.00 / $2,910.00
| Facility | | $2,910.00 | $2,910.00 | $2,910.00 |