- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $323.59 / $3,801.89 / $5,623.41
| Facility | | $323.59 | $3,801.89 | $5,623.41 |
- 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
- $288.40 / $302.00 / $338.84
| Facility | | $288.40 | $302.00 | $338.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $512.86 / $512.86 / $851.14
| Facility | | $512.86 | $512.86 | $851.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $977.24 / $3,715.35 / $6,456.54
| Facility | | $977.24 | $3,715.35 | $6,456.54 |