- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $602.56 / $2,818.38 / $10,471.29
| Facility | | $602.56 | $2,818.38 | $10,471.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,818.38 / $4,466.84 / $12,022.64
| Facility | | $2,818.38 | $4,466.84 | $12,022.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $524.81 / $724.44 / $933.25
| Facility | | $524.81 | $724.44 | $933.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $977.24 / $977.24 / $2,511.89
| Facility | | $977.24 | $977.24 | $2,511.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $851.14 / $4,677.35 / $10,000.00
| Facility | | $851.14 | $4,677.35 | $10,000.00 |