- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $645.65 / $1,659.59 / $4,168.69
| Facility | | $645.65 | $1,659.59 | $4,168.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,621.81 / $2,691.53 / $4,073.80
| Facility | | $1,621.81 | $2,691.53 | $4,073.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $39.81 / $1,737.80 / $1,737.80
| Facility | | $39.81 | $1,737.80 | $1,737.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $724.44 / $724.44 / $724.44
| Facility | | $724.44 | $724.44 | $724.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $831.76 / $2,398.83 / $5,888.44
| Facility | | $831.76 | $2,398.83 | $5,888.44 |