- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $416.87 / $645.65 / $645.65
| Facility | | $416.87 | $645.65 | $645.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $776.25 / $5,495.41 / $13,182.57
| Facility | | $776.25 | $5,495.41 | $13,182.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,659.59 / $2,344.23 / $5,495.41
| Facility | | $1,659.59 | $2,344.23 | $5,495.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,778.28 / $2,238.72 / $4,365.16
| Facility | | $1,778.28 | $2,238.72 | $4,365.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $426.58 / $870.96 / $1,905.46
| Facility | | $426.58 | $870.96 | $1,905.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,380.38 / $3,467.37 / $7,079.46
| Facility | | $1,380.38 | $3,467.37 | $7,079.46 |