- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $562.34 / $2,818.38 / $9,772.37
| Facility | | $562.34 | $2,818.38 | $9,772.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,630.27 / $4,073.80 / $9,549.93
| Facility | | $2,630.27 | $4,073.80 | $9,549.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $537.03 / $724.44 / $870.96
| Facility | | $537.03 | $724.44 | $870.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $660.69 / $977.24 / $2,290.87
| Facility | | $660.69 | $977.24 | $2,290.87 |
- 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 |