- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $758.58 / $1,905.46 / $4,073.80
| Facility | | $758.58 | $1,905.46 | $4,073.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,380.38 / $2,818.38 / $3,801.89
| Facility | | $1,380.38 | $2,818.38 | $3,801.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $389.05 / $1,023.29 / $1,949.84
| Facility | | $389.05 | $1,023.29 | $1,949.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $54.95 / $56.23 / $4,897.79
| Facility | | $54.95 | $56.23 | $4,897.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,023.29 / $2,187.76 / $3,981.07
| Facility | | $1,023.29 | $2,187.76 | $3,981.07 |