- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $812.83 / $4,897.79 / $11,220.18
| Facility | | $812.83 | $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
- $478.63 / $524.81 / $588.84
| Facility | | $478.63 | $524.81 | $588.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $588.84 / $870.96 / $1,621.81
| Facility | | $588.84 | $870.96 | $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 |