- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,506.15 / $5,463.36 / $13,841.56
| Facility | | $1,506.15 | $5,463.36 | $13,841.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,243.81 / $3,040.94 / $5,708.62
| Facility | | $2,243.81 | $3,040.94 | $5,708.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $202.43 / $803.07 / $1,124.23
| Facility | | $202.43 | $803.07 | $1,124.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $364.39 / $1,161.94 / $1,530.80
| Facility | | $364.39 | $1,161.94 | $1,530.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,775.00 / $3,227.00 / $6,169.00
| Facility | | $1,775.00 | $3,227.00 | $6,169.00 |