- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,258.93 / $4,897.79 / $16,218.10
| Facility | | $1,258.93 | $4,897.79 | $16,218.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,570.88 / $35,481.34 / $52,480.75
| Facility | | $4,570.88 | $35,481.34 | $52,480.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $794.33 / $870.96 / $1,000.00
| Facility | | $794.33 | $870.96 | $1,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $954.99 / $1,380.38 / $1,949.84
| Facility | | $954.99 | $1,380.38 | $1,949.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,011.87 / $11,748.98 / $17,378.01
| Facility | | $5,011.87 | $11,748.98 | $17,378.01 |