- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $186.21 / $3,801.89 / $6,606.93
| Facility | | $186.21 | $3,801.89 | $6,606.93 |
- 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
- $162.18 / $169.82 / $190.55
| Facility | | $162.18 | $169.82 | $190.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $288.40 / $288.40 / $1,148.15
| Facility | | $288.40 | $288.40 | $1,148.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,412.54 / $3,715.35 / $6,456.54
| Facility | | $1,412.54 | $3,715.35 | $6,456.54 |