- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $537.03 / $7,244.36 / $16,595.87
| Facility | | $537.03 | $7,244.36 | $16,595.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $707.95 / $3,311.31 / $8,709.64
| Facility | | $707.95 | $3,311.31 | $8,709.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $331.13 / $562.34 / $1,148.15
| Facility | | $331.13 | $562.34 | $1,148.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $190.55 / $263.03 / $426.58
| Facility | | $190.55 | $263.03 | $426.58 |
- 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 |