- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $263.03 / $3,467.37 / $7,244.36
| Facility | | $263.03 | $3,467.37 | $7,244.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,265.80 / $8,709.64 / $11,220.18
| Facility | | $4,265.80 | $8,709.64 | $11,220.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $213.80 / $234.42 / $251.19
| Facility | | $213.80 | $234.42 | $251.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $234.42 / $371.54 / $380.19
| Facility | | $234.42 | $371.54 | $380.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,288.25 / $2,818.38 / $4,265.80
| Facility | | $1,288.25 | $2,818.38 | $4,265.80 |