- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $457.09 / $2,630.27 / $8,511.38
| Facility | | $457.09 | $2,630.27 | $8,511.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,244.36 / $10,715.19 / $11,220.18
| Facility | | $7,244.36 | $10,715.19 | $11,220.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $302.00 / $426.58 / $512.86
| Facility | | $302.00 | $426.58 | $512.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $34.67 / $575.44 / $575.44
| Facility | | $34.67 | $575.44 | $575.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $4,677.35 / $81,283.05
| Facility | | $1,000.00 | $4,677.35 | $81,283.05 |