- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $309.03 / $1,778.28 / $8,511.38
| Facility | | $309.03 | $1,778.28 | $8,511.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,120.11 / $10,715.19 / $11,220.18
| Facility | | $9,120.11 | $10,715.19 | $11,220.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $269.15 / $389.05 / $457.09
| Facility | | $269.15 | $389.05 | $457.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $34.67 / $524.81 / $524.81
| Facility | | $34.67 | $524.81 | $524.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $851.14 / $4,677.35 / $10,000.00
| Facility | | $851.14 | $4,677.35 | $10,000.00 |