- 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
- $2,915.20 / $3,950.84 / $7,416.73
| Facility | | $2,915.20 | $3,950.84 | $7,416.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $279.33 / $1,200.50 / $2,037.77
| Facility | | $279.33 | $1,200.50 | $2,037.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $505.41 / $1,535.87 / $2,353.30
| Facility | | $505.41 | $1,535.87 | $2,353.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,341.00 / $7,441.00 / $8,816.00
| Facility | | $5,341.00 | $7,441.00 | $8,816.00 |