- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $138.04 / $1,230.27 / $6,025.60
| Facility | | $138.04 | $1,230.27 | $6,025.60 |
- 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
- $112.20 / $117.49 / $131.83
| Facility | | $112.20 | $117.49 | $131.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $131.83 / $245.47 / $1,621.81
| Facility | | $131.83 | $245.47 | $1,621.81 |
- 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 |