- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $234.42 / $4,897.79 / $16,595.87
| Facility | | $234.42 | $4,897.79 | $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
- $141.25 / $575.44 / $1,148.15
| Facility | | $141.25 | $575.44 | $1,148.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $87.10 / $288.40 / $1,819.70
| Facility | | $87.10 | $288.40 | $1,819.70 |
- 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 |