- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $452.26 / $4,124.66 / $9,213.69
| Facility | | $452.26 | $4,124.66 | $9,213.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,318.00 / $6,474.00 / $13,758.00
| Facility | | $2,318.00 | $6,474.00 | $13,758.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $439.44 / $571.27 / $659.16
| Facility | | $439.44 | $571.27 | $659.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,623.15 / $2,623.15 / $3,109.49
| Facility | | $2,623.15 | $2,623.15 | $3,109.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,932.00 / $8,348.00 / $12,569.00
| Facility | | $3,932.00 | $8,348.00 | $12,569.00 |