- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $371.54 / $371.54 / $6,760.83
| Facility | | $371.54 | $371.54 | $6,760.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $891.25 / $891.25 / $10,471.29
| Facility | | $891.25 | $891.25 | $10,471.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $794.33 / $1,348.96 / $3,388.44
| Facility | | $794.33 | $1,348.96 | $3,388.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $891.25 / $1,348.96 / $2,691.53
| Facility | | $891.25 | $1,348.96 | $2,691.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $380.19 / $602.56 / $1,174.90
| Facility | | $380.19 | $602.56 | $1,174.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,778.28 / $5,754.40 / $9,772.37
| Facility | | $1,778.28 | $5,754.40 | $9,772.37 |