- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,318.31 / $5,463.36 / $13,841.56
| Facility | | $2,318.31 | $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
- $216.14 / $378.25 / $702.77
| Facility | | $216.14 | $378.25 | $702.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $433.94 / $618.39 / $1,522.92
| Facility | | $433.94 | $618.39 | $1,522.92 |
- 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 |