- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $144.54 / $2,754.23 / $4,897.79
| Facility | | $144.54 | $2,754.23 | $4,897.79 |
- 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
- $117.49 / $123.03 / $138.04
| Facility | | $117.49 | $123.03 | $138.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $138.04 / $199.53 / $346.74
| Facility | | $138.04 | $199.53 | $346.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $758.58 / $3,715.35 / $6,456.54
| Facility | | $758.58 | $3,715.35 | $6,456.54 |