- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,096.48 / $4,897.79 / $11,220.18
| Facility | | $1,096.48 | $4,897.79 | $11,220.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,715.35 / $13,803.84 / $19,054.61
| Facility | | $3,715.35 | $13,803.84 | $19,054.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $741.31 / $741.31 / $758.58
| Facility | | $741.31 | $741.31 | $758.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $776.25 / $954.99 / $1,412.54
| Facility | | $776.25 | $954.99 | $1,412.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,398.83 / $3,715.35 / $6,456.54
| Facility | | $2,398.83 | $3,715.35 | $6,456.54 |