- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $251.19 / $2,398.83 / $7,762.47
| Facility | | $251.19 | $2,398.83 | $7,762.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,659.59 / $3,981.07 / $5,888.44
| Facility | | $1,659.59 | $3,981.07 | $5,888.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $269.15 / $1,659.59 / $3,019.95
| Facility | | $269.15 | $1,659.59 | $3,019.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,943.28 / $7,943.28 / $45,708.82
| Facility | | $7,943.28 | $7,943.28 | $45,708.82 |
- 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 |