- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $257.04 / $2,344.23 / $4,897.79
| Facility | | $257.04 | $2,344.23 | $4,897.79 |
- 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
- $223.87 / $239.88 / $263.03
| Facility | | $223.87 | $239.88 | $263.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $245.47 / $380.19 / $501.19
| Facility | | $245.47 | $380.19 | $501.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,412.54 / $5,754.40 / $12,022.64
| Facility | | $1,412.54 | $5,754.40 | $12,022.64 |