- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $831.76 / $2,691.53 / $6,025.60
| Facility | | $831.76 | $2,691.53 | $6,025.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,511.89 / $4,265.80 / $6,309.57
| Facility | | $2,511.89 | $4,265.80 | $6,309.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $39.81 / $2,754.23 / $2,754.23
| Facility | | $39.81 | $2,754.23 | $2,754.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,348.96 / $1,348.96 / $1,348.96
| Facility | | $1,348.96 | $1,348.96 | $1,348.96 |
- 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 |