- 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
- $3,100.60 / $4,495.00 / $7,888.43
| Facility | | $3,100.60 | $4,495.00 | $7,888.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $250.14 / $1,156.69 / $2,641.16
| Facility | | $250.14 | $1,156.69 | $2,641.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $604.40 / $2,073.31 / $3,407.89
| Facility | | $604.40 | $2,073.31 | $3,407.89 |
- 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 |