- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $457.09 / $4,897.79 / $16,595.87
| Facility | | $457.09 | $4,897.79 | $16,595.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $707.95 / $1,737.80 / $4,570.88
| Facility | | $707.95 | $1,737.80 | $4,570.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $288.40 / $537.03 / $1,096.48
| Facility | | $288.40 | $537.03 | $1,096.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $162.18 / $223.87 / $363.08
| Facility | | $162.18 | $223.87 | $363.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $616.60 / $6,309.57 / $10,000.00
| Facility | | $616.60 | $6,309.57 | $10,000.00 |