- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,023.29 / $3,162.28 / $6,606.93
| Facility | | $1,023.29 | $3,162.28 | $6,606.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,168.69 / $5,623.41 / $7,585.78
| Facility | | $4,168.69 | $5,623.41 | $7,585.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $39.81 / $39.81 / $1,445.44
| Facility | | $39.81 | $39.81 | $1,445.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $398.11 / $398.11 / $398.11
| Facility | | $398.11 | $398.11 | $398.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,174.90 / $6,456.54 / $16,218.10
| Facility | | $1,174.90 | $6,456.54 | $16,218.10 |