- 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
- $5,121.08 / $6,735.62 / $13,028.86
| Facility | | $5,121.08 | $6,735.62 | $13,028.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $501.81 / $908.97 / $4,800.83
| Facility | | $501.81 | $908.97 | $4,800.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $897.37 / $1,237.61 / $2,510.01
| Facility | | $897.37 | $1,237.61 | $2,510.01 |
- 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 |