- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $421.37 / $3,500.00 / $15,224.70
| Facility | | $421.37 | $3,500.00 | $15,224.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,310.00 / $5,750.00 / $15,727.00
| Facility | | $2,310.00 | $5,750.00 | $15,727.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $386.80 / $502.84 / $580.20
| Facility | | $386.80 | $502.84 | $580.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $486.62 / $538.00 / $3,624.17
| Facility | | $486.62 | $538.00 | $3,624.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,500.00 / $5,995.00 / $9,243.00
| Facility | | $1,500.00 | $5,995.00 | $9,243.00 |