- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $645.65 / $7,244.36 / $16,595.87
| Facility | | $645.65 | $7,244.36 | $16,595.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $524.81 / $1,737.80 / $4,570.88
| Facility | | $524.81 | $1,737.80 | $4,570.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $371.54 / $537.03 / $1,096.48
| Facility | | $371.54 | $537.03 | $1,096.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $229.09 / $316.23 / $524.81
| Facility | | $229.09 | $316.23 | $524.81 |
- 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 |