- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $637.00 / $1,177.46 / $8,229.00
| Facility | | $637.00 | $1,177.46 | $8,229.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,643.00 / $3,428.00 / $8,517.00
| Facility | | $1,643.00 | $3,428.00 | $8,517.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,091.83 / $1,329.46 / $1,552.11
| Facility | | $1,091.83 | $1,329.46 | $1,552.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,156.61 / $1,337.65 / $1,829.00
| Facility | | $1,156.61 | $1,337.65 | $1,829.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $523.00 / $1,450.00 / $4,039.00
| Facility | | $523.00 | $1,450.00 | $4,039.00 |