- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $776.25 / $1,548.82 / $1,548.82
| Facility | | $776.25 | $1,548.82 | $1,548.82 |
- 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
- $549.54 / $691.83 / $851.14
| Facility | | $549.54 | $691.83 | $851.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $776.25 / $776.25 / $1,548.82
| Facility | | $776.25 | $776.25 | $1,548.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $512.86 / $602.56 / $870.96
| Facility | | $512.86 | $602.56 | $870.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $537.03 / $2,344.23 / $5,888.44
| Facility | | $537.03 | $2,344.23 | $5,888.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $758.58 / $8,709.64 / $18,197.01
| Facility | | $758.58 | $8,709.64 | $18,197.01 |