- 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
- $4,211.62 / $5,707.82 / $10,715.04
| Facility | | $4,211.62 | $5,707.82 | $10,715.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $295.83 / $395.20 / $2,645.44
| Facility | | $295.83 | $395.20 | $2,645.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $209.07 / $589.57 / $989.07
| Facility | | $209.07 | $589.57 | $989.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,031.00 / $1,775.00 / $4,406.00
| Facility | | $1,031.00 | $1,775.00 | $4,406.00 |