- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $288.40 / $3,801.89 / $11,220.18
| Facility | | $288.40 | $3,801.89 | $11,220.18 |
- 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
- $190.55 / $194.98 / $223.87
| Facility | | $190.55 | $194.98 | $223.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $331.13 / $758.58 / $1,862.09
| Facility | | $331.13 | $758.58 | $1,862.09 |
- 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 |