- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $738.50 / $3,119.00 / $7,522.42
| Facility | | $738.50 | $3,119.00 | $7,522.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,232.00 / $4,286.00 / $9,663.00
| Facility | | $2,232.00 | $4,286.00 | $9,663.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,524.00 / $9,308.00 / $10,577.00
| Facility | | $4,524.00 | $9,308.00 | $10,577.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $311.58 / $518.98 / $3,532.00
| Facility | | $311.58 | $518.98 | $3,532.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,694.00 / $3,018.00 / $5,813.00
| Facility | | $1,694.00 | $3,018.00 | $5,813.00 |