- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $758.58 / $2,041.74 / $4,570.88
| Facility | | $758.58 | $2,041.74 | $4,570.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,290.87 / $4,365.16 / $6,165.95
| Facility | | $2,290.87 | $4,365.16 | $6,165.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $39.81 / $2,137.96 / $2,137.96
| Facility | | $39.81 | $2,137.96 | $2,137.96 |
- 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 / $4,677.35
| Facility | | $467.74 | $1,621.81 | $4,677.35 |