- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,398.83 / $2,691.53 / $7,585.78
| Facility | | $2,398.83 | $2,691.53 | $7,585.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,548.13 / $8,709.64 / $14,454.40
| Facility | | $3,548.13 | $8,709.64 | $14,454.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $501.19 / $524.81 / $2,290.87
| Facility | | $501.19 | $524.81 | $2,290.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $54.95 / $16,982.44 / $16,982.44
| Facility | | $54.95 | $16,982.44 | $16,982.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,258.93 / $3,548.13 / $6,025.60
| Facility | | $1,258.93 | $3,548.13 | $6,025.60 |