- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $363.08 / $363.08 / $1,584.89
| Facility | | $363.08 | $363.08 | $1,584.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $426.58 / $426.58 / $512.86
| Facility | | $426.58 | $426.58 | $512.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $676.08 / $676.08 / $1,659.59
| Facility | | $676.08 | $676.08 | $1,659.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $19,054.61 / $19,054.61 / $19,054.61
| Facility | | $19,054.61 | $19,054.61 | $19,054.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,548.13 / $3,548.13 / $24,547.09
| Facility | | $3,548.13 | $3,548.13 | $24,547.09 |