- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $331.13 / $1,778.28 / $8,511.38
| Facility | | $331.13 | $1,778.28 | $8,511.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,344.23 / $3,801.89 / $8,511.38
| Facility | | $2,344.23 | $3,801.89 | $8,511.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $309.03 / $436.52 / $512.86
| Facility | | $309.03 | $436.52 | $512.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $389.05 / $588.84 / $1,862.09
| Facility | | $389.05 | $588.84 | $1,862.09 |
- 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 |