- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,149.67 / $5,463.36 / $13,841.56
| Facility | | $2,149.67 | $5,463.36 | $13,841.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,665.88 / $3,864.78 / $6,782.44
| Facility | | $2,665.88 | $3,864.78 | $6,782.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $146.68 / $678.93 / $4,006.82
| Facility | | $146.68 | $678.93 | $4,006.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $351.25 / $3,518.85 / $6,569.28
| Facility | | $351.25 | $3,518.85 | $6,569.28 |
- 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 |