- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,653.00 / $5,463.36 / $13,841.56
| Facility | | $1,653.00 | $5,463.36 | $13,841.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,398.31 / $3,250.33 / $6,101.70
| Facility | | $2,398.31 | $3,250.33 | $6,101.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $403.83 / $664.91 / $5,668.62
| Facility | | $403.83 | $664.91 | $5,668.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $771.87 / $1,054.01 / $2,691.59
| Facility | | $771.87 | $1,054.01 | $2,691.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,217.00 / $6,451.00 / $7,934.00
| Facility | | $4,217.00 | $6,451.00 | $7,934.00 |