- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $707.95 / $2,089.30 / $4,897.79
| Facility | | $707.95 | $2,089.30 | $4,897.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,318.26 / $2,754.23 / $4,365.16
| Facility | | $1,318.26 | $2,754.23 | $4,365.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $39.81 / $162.18 / $162.18
| Facility | | $39.81 | $162.18 | $162.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,202.26 / $1,202.26 / $1,202.26
| Facility | | $1,202.26 | $1,202.26 | $1,202.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $467.74 / $1,479.11 / $3,981.07
| Facility | | $467.74 | $1,479.11 | $3,981.07 |