- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $457.09 / $3,162.28 / $9,120.11
| Facility | | $457.09 | $3,162.28 | $9,120.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,715.35 / $8,317.64 / $10,471.29
| Facility | | $3,715.35 | $8,317.64 | $10,471.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $363.08 / $380.19 / $426.58
| Facility | | $363.08 | $380.19 | $426.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $380.19 / $602.56 / $758.58
| Facility | | $380.19 | $602.56 | $758.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,884.03 / $6,025.60 / $10,715.19
| Facility | | $2,884.03 | $6,025.60 | $10,715.19 |