- 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
- $2,252.94 / $3,266.13 / $5,731.84
| Facility | | $2,252.94 | $3,266.13 | $5,731.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $90.55 / $158.46 / $242.22
| Facility | | $90.55 | $158.46 | $242.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $175.00 / $226.35 / $319.12
| Facility | | $175.00 | $226.35 | $319.12 |
- 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 |