- 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
- $223.87 / $933.25 / $1,862.09
| Facility | | $223.87 | $933.25 | $1,862.09 |
- 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
- $1,174.90 / $3,548.13 / $6,025.60
| Facility | | $1,174.90 | $3,548.13 | $6,025.60 |