- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,096.48 / $1,096.48 / $1,096.48
| Facility | | $1,096.48 | $1,096.48 | $1,096.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $239.88 / $524.81 / $870.96
| Facility | | $239.88 | $524.81 | $870.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,819.70 / $1,819.70 / $2,187.76
| Facility | | $1,819.70 | $1,819.70 | $2,187.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $218.78 / $281.84 / $309.03
| Facility | | $218.78 | $281.84 | $309.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1.20 / $45.71 / $1,819.70
| Facility | | $1.20 | $45.71 | $1,819.70 |