- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,019.95 / $3,019.95 / $3,090.30
| Facility | | $3,019.95 | $3,019.95 | $3,090.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $186.21 / $346.74 / $1,348.96
| Facility | | $186.21 | $346.74 | $1,348.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12.02 / $26.92 / $67.61
| Facility | | $12.02 | $26.92 | $67.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $758.58 / $758.58 / $758.58
| Facility | | $758.58 | $758.58 | $758.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $741.31 / $3,019.95 / $3,090.30
| Facility | | $741.31 | $3,019.95 | $3,090.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $34.67 / $457.09 / $562.34
| Facility | | $34.67 | $457.09 | $562.34 |