- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $562.34 / $562.34 / $1,584.89
| Facility | | $562.34 | $562.34 | $1,584.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $645.65 / $645.65 / $776.25
| Facility | | $645.65 | $645.65 | $776.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $34.67 / $1,023.29 / $1,023.29
| Facility | | $34.67 | $1,023.29 | $1,023.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $23,442.29 / $23,442.29 / $87,096.36
| Facility | | $23,442.29 | $23,442.29 | $87,096.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $34,673.69 / $34,673.69 / $123,026.88
| Facility | | $34,673.69 | $34,673.69 | $123,026.88 |