- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,318.31 / $6,048.00 / $13,841.56
| Facility | | $2,318.31 | $6,048.00 | $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
- $217.65 / $380.89 / $695.19
| Facility | | $217.65 | $380.89 | $695.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $437.61 / $603.79 / $1,522.92
| Facility | | $437.61 | $603.79 | $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 |