- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $977.24 / $2,630.27 / $7,585.78
| Facility | | $977.24 | $2,630.27 | $7,585.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,737.80 / $5,888.44 / $9,772.37
| Facility | | $1,737.80 | $5,888.44 | $9,772.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $501.19 / $891.25 / $6,309.57
| Facility | | $501.19 | $891.25 | $6,309.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $54.95 / $16,595.87 / $16,595.87
| Facility | | $54.95 | $16,595.87 | $16,595.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,187.76 / $5,623.41 / $10,000.00
| Facility | | $2,187.76 | $5,623.41 | $10,000.00 |