- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $467.74 / $2,137.96 / $4,073.80
| Facility | | $467.74 | $2,137.96 | $4,073.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,288.25 / $2,754.23 / $3,801.89
| Facility | | $1,288.25 | $2,754.23 | $3,801.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $173.78 / $501.19 / $1,659.59
| Facility | | $173.78 | $501.19 | $1,659.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,897.79 / $4,897.79 / $19,498.45
| Facility | | $4,897.79 | $4,897.79 | $19,498.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $2,187.76 / $3,981.07
| Facility | | $1,000.00 | $2,187.76 | $3,981.07 |