- 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
- $4,616.14 / $6,256.05 / $11,744.20
| Facility | | $4,616.14 | $6,256.05 | $11,744.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $204.03 / $461.38 / $2,552.80
| Facility | | $204.03 | $461.38 | $2,552.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $375.55 / $648.91 / $1,425.85
| Facility | | $375.55 | $648.91 | $1,425.85 |
- 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 |