- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $851.14 / $1,737.80 / $5,495.41
| Facility | | $851.14 | $1,737.80 | $5,495.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $912.01 / $6,309.57 / $6,309.57
| Facility | | $912.01 | $6,309.57 | $6,309.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $851.14 / $1,737.80 / $5,495.41
| Facility | | $851.14 | $1,737.80 | $5,495.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $831.76 / $933.25 / $1,071.52
| Facility | | $831.76 | $933.25 | $1,071.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $831.76 / $933.25 / $1,096.48
| Facility | | $831.76 | $933.25 | $1,096.48 |