- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,041.74 / $4,365.16 / $7,943.28
| Facility | | $2,041.74 | $4,365.16 | $7,943.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $776.25 / $2,041.74 / $3,801.89
| Facility | | $776.25 | $2,041.74 | $3,801.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $630.96 / $1,584.89 / $2,570.40
| Facility | | $630.96 | $1,584.89 | $2,570.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $478.63 / $630.96 / $3,630.78
| Facility | | $478.63 | $630.96 | $3,630.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,949.84 / $2,951.21 / $5,370.32
| Facility | | $1,949.84 | $2,951.21 | $5,370.32 |