- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,318.31 / $5,463.36 / $13,841.56
| Facility | | $2,318.31 | $5,463.36 | $13,841.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,474.97 / $6,064.74 / $11,385.07
| Facility | | $4,474.97 | $6,064.74 | $11,385.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $173.63 / $336.58 / $7,772.00
| Facility | | $173.63 | $336.58 | $7,772.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $326.47 / $435.03 / $3,093.19
| Facility | | $326.47 | $435.03 | $3,093.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,957.96 / $4,706.76 / $7,772.00
| Facility | | $3,957.96 | $4,706.76 | $7,772.00 |