- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,023.29 / $4,786.30 / $16,218.10
| Facility | | $1,023.29 | $4,786.30 | $16,218.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,570.88 / $14,125.38 / $19,054.61
| Facility | | $4,570.88 | $14,125.38 | $19,054.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $645.65 / $724.44 / $812.83
| Facility | | $645.65 | $724.44 | $812.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $724.44 / $1,148.15 / $1,621.81
| Facility | | $724.44 | $1,148.15 | $1,621.81 |
- 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 |