- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,288.25 / $1,288.25 / $1,288.25
| Facility | | $1,288.25 | $1,288.25 | $1,288.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $524.81 / $691.83 / $1,513.56
| Facility | | $524.81 | $691.83 | $1,513.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,897.79 / $4,897.79 / $5,370.32
| Facility | | $4,897.79 | $4,897.79 | $5,370.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $331.13 / $457.09 / $645.65
| Facility | | $331.13 | $457.09 | $645.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1.29 / $46.77 / $1,862.09
| Facility | | $1.29 | $46.77 | $1,862.09 |