- 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
- $3,551.47 / $5,148.63 / $9,035.51
| Facility | | $3,551.47 | $5,148.63 | $9,035.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $149.60 / $254.32 / $753.88
| Facility | | $149.60 | $254.32 | $753.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $299.67 / $399.29 / $599.36
| Facility | | $299.67 | $399.29 | $599.36 |
- 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 |