- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,023.29 / $2,089.30 / $8,128.31
| Facility | | $1,023.29 | $2,089.30 | $8,128.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,168.69 / $28,183.83 / $39,810.72
| Facility | | $4,168.69 | $28,183.83 | $39,810.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $660.69 / $724.44 / $812.83
| Facility | | $660.69 | $724.44 | $812.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $724.44 / $977.24 / $1,778.28
| Facility | | $724.44 | $977.24 | $1,778.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,388.44 / $6,025.60 / $12,022.64
| Facility | | $3,388.44 | $6,025.60 | $12,022.64 |