- 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
- $5,198.33 / $7,045.08 / $13,225.41
| Facility | | $5,198.33 | $7,045.08 | $13,225.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $94.32 / $207.47 / $5,444.45
| Facility | | $94.32 | $207.47 | $5,444.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $178.33 / $237.83 / $1,813.25
| Facility | | $178.33 | $237.83 | $1,813.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,217.00 / $6,451.00 / $7,934.00
| Facility | | $4,217.00 | $6,451.00 | $7,934.00 |