- 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
- $1,584.89 / $1,584.89 / $1,584.89
| Facility | | $1,584.89 | $1,584.89 | $1,584.89 |
- 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 / $1,288.25 / $1,737.80
| Facility | | $1,071.52 | $1,288.25 | $1,737.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,071.52 / $1,288.25 / $1,737.80
| Facility | | $1,071.52 | $1,288.25 | $1,737.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,122.02 / $6,025.60 / $17,378.01
| Facility | | $1,122.02 | $6,025.60 | $17,378.01 |