- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $427.44 / $3,500.00 / $10,624.24
| Facility | | $427.44 | $3,500.00 | $10,624.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,140.00 / $5,958.00 / $9,462.00
| Facility | | $2,140.00 | $5,958.00 | $9,462.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $385.41 / $501.03 / $693.41
| Facility | | $385.41 | $501.03 | $693.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $615.00 / $715.56 / $1,873.52
| Facility | | $615.00 | $715.56 | $1,873.52 |
- 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 |