- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $524.81 / $1,621.81 / $4,073.80
| Facility | | $524.81 | $1,621.81 | $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
- $218.78 / $1,023.29 / $1,862.09
| Facility | | $218.78 | $1,023.29 | $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
- $912.01 / $2,187.76 / $3,981.07
| Facility | | $912.01 | $2,187.76 | $3,981.07 |