- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,318.26 / $4,897.79 / $16,218.10
| Facility | | $1,318.26 | $4,897.79 | $16,218.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,623.41 / $18,197.01 / $26,302.68
| Facility | | $5,623.41 | $18,197.01 | $26,302.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $891.25 / $912.01 / $1,047.13
| Facility | | $891.25 | $912.01 | $1,047.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $933.25 / $1,479.11 / $1,995.26
| Facility | | $933.25 | $1,479.11 | $1,995.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,466.84 / $9,549.93 / $16,218.10
| Facility | | $4,466.84 | $9,549.93 | $16,218.10 |