- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,166.29 / $5,463.36 / $13,841.56
| Facility | | $2,166.29 | $5,463.36 | $13,841.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,243.81 / $3,040.94 / $5,708.62
| Facility | | $2,243.81 | $3,040.94 | $5,708.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $90.37 / $177.27 / $3,499.00
| Facility | | $90.37 | $177.27 | $3,499.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $173.43 / $237.77 / $711.69
| Facility | | $173.43 | $237.77 | $711.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,775.00 / $3,227.00 / $6,169.00
| Facility | | $1,775.00 | $3,227.00 | $6,169.00 |