- 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
- $4,211.62 / $5,707.82 / $10,715.04
| Facility | | $4,211.62 | $5,707.82 | $10,715.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $167.87 / $1,185.09 / $2,601.90
| Facility | | $167.87 | $1,185.09 | $2,601.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $338.83 / $1,428.21 / $2,893.18
| Facility | | $338.83 | $1,428.21 | $2,893.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,679.00 / $3,167.00 / $7,934.00
| Facility | | $2,679.00 | $3,167.00 | $7,934.00 |