- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $427.75 / $1,547.00 / $7,866.50
| Facility | | $427.75 | $1,547.00 | $7,866.50 |
- 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
- $337.13 / $582.32 / $3,532.00
| Facility | | $337.13 | $582.32 | $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 |