- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $218.78 / $1,995.26 / $5,623.41
| Facility | | $218.78 | $1,995.26 | $5,623.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,187.76 / $8,317.64 / $10,471.29
| Facility | | $2,187.76 | $8,317.64 | $10,471.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $177.83 / $199.53 / $223.87
| Facility | | $177.83 | $199.53 | $223.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $218.78 / $309.03 / $446.68
| Facility | | $218.78 | $309.03 | $446.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,348.96 / $3,715.35 / $6,456.54
| Facility | | $1,348.96 | $3,715.35 | $6,456.54 |