- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $457.09 / $4,897.79 / $8,511.38
| Facility | | $457.09 | $4,897.79 | $8,511.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,715.35 / $4,365.16 / $10,964.78
| Facility | | $3,715.35 | $4,365.16 | $10,964.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,023.29 / $2,187.76 / $3,548.13
| Facility | | $1,023.29 | $2,187.76 | $3,548.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $758.58 / $758.58 / $758.58
| Facility | | $758.58 | $758.58 | $758.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $831.76 / $6,760.83 / $10,000.00
| Facility | | $831.76 | $6,760.83 | $10,000.00 |