- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,819.70 / $4,786.30 / $8,317.64
| Facility | | $1,819.70 | $4,786.30 | $8,317.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $575.44 / $3,890.45 / $4,073.80
| Facility | | $575.44 | $3,890.45 | $4,073.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $794.33 / $794.33 / $2,187.76
| Facility | | $794.33 | $794.33 | $2,187.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $870.96 / $1,230.27 / $6,309.57
| Facility | | $870.96 | $1,230.27 | $6,309.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,778.28 / $2,818.38 / $6,309.57
| Facility | | $1,778.28 | $2,818.38 | $6,309.57 |