- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $467.74 / $1,819.70 / $2,691.53
| Facility | | $467.74 | $1,819.70 | $2,691.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,513.56 / $3,890.45 / $5,888.44
| Facility | | $1,513.56 | $3,890.45 | $5,888.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $371.54 / $1,513.56 / $1,862.09
| Facility | | $371.54 | $1,513.56 | $1,862.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,943.28 / $7,943.28 / $19,498.45
| Facility | | $7,943.28 | $7,943.28 | $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 |