- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $660.69 / $2,818.38 / $10,471.29
| Facility | | $660.69 | $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
- $457.09 / $562.34 / $794.33
| Facility | | $457.09 | $562.34 | $794.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $912.01 / $912.01 / $2,511.89
| Facility | | $912.01 | $912.01 | $2,511.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $724.44 / $2,511.89 / $10,000.00
| Facility | | $724.44 | $2,511.89 | $10,000.00 |