- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,152.06 / $7,119.04 / $19,276.96
| Facility | | $3,152.06 | $7,119.04 | $19,276.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,020.60 / $5,448.94 / $10,229.04
| Facility | | $4,020.60 | $5,448.94 | $10,229.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $212.40 / $416.01 / $4,706.76
| Facility | | $212.40 | $416.01 | $4,706.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $366.75 / $540.69 / $2,929.96
| Facility | | $366.75 | $540.69 | $2,929.96 |
- 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 |