- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $616.60 / $741.31 / $1,412.54
| Facility | | $616.60 | $741.31 | $1,412.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $97.72 / $169.82 / $389.05
| Facility | | $97.72 | $169.82 | $389.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $302.00 / $3,090.30 / $3,890.45
| Facility | | $302.00 | $3,090.30 | $3,890.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $54.95 / $77.62 / $162.18
| Facility | | $54.95 | $77.62 | $162.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,445.44 / $1,445.44 / $1,445.44
| Facility | | $1,445.44 | $1,445.44 | $1,445.44 |