- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $776.25 / $1,548.82 / $2,691.53
| Facility | | $776.25 | $1,548.82 | $2,691.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $912.01 / $1,047.13 / $1,288.25
| Facility | | $912.01 | $1,047.13 | $1,288.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $389.05 / $1,047.13 / $1,479.11
| Facility | | $389.05 | $1,047.13 | $1,479.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $776.25 / $1,548.82 / $2,691.53
| Facility | | $776.25 | $1,548.82 | $2,691.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,071.52 / $1,071.52 / $1,122.02
| Facility | | $1,071.52 | $1,071.52 | $1,122.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,071.52 / $1,071.52 / $1,122.02
| Facility | | $1,071.52 | $1,071.52 | $1,122.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,412.54 / $9,549.93 / $18,197.01
| Facility | | $1,412.54 | $9,549.93 | $18,197.01 |