- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,096.48 / $5,248.07 / $17,378.01
| Facility | | $1,096.48 | $5,248.07 | $17,378.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,623.41 / $14,125.38 / $19,054.61
| Facility | | $5,623.41 | $14,125.38 | $19,054.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $758.58 / $831.76 / $954.99
| Facility | | $758.58 | $831.76 | $954.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $891.25 / $1,380.38 / $1,905.46
| Facility | | $891.25 | $1,380.38 | $1,905.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,691.53 / $7,762.47 / $10,964.78
| Facility | | $2,691.53 | $7,762.47 | $10,964.78 |