- 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
- $5,303.68 / $6,975.78 / $13,493.42
| Facility | | $5,303.68 | $6,975.78 | $13,493.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $207.02 / $368.36 / $3,044.00
| Facility | | $207.02 | $368.36 | $3,044.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $274.81 / $529.11 / $742.51
| Facility | | $274.81 | $529.11 | $742.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,044.00 / $3,726.00 / $7,934.00
| Facility | | $3,044.00 | $3,726.00 | $7,934.00 |