- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $758.58 / $2,041.74 / $4,897.79
| Facility | | $758.58 | $2,041.74 | $4,897.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,290.87 / $3,801.89 / $6,025.60
| Facility | | $2,290.87 | $3,801.89 | $6,025.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $39.81 / $3,548.13 / $3,548.13
| Facility | | $39.81 | $3,548.13 | $3,548.13 |
- 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 / $1,621.81 / $4,897.79
| Facility | | $467.74 | $1,621.81 | $4,897.79 |