- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $756.00 / $1,471.68 / $8,229.00
| Facility | | $756.00 | $1,471.68 | $8,229.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,088.00 / $3,967.00 / $8,800.00
| Facility | | $2,088.00 | $3,967.00 | $8,800.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $922.91 / $1,295.84 / $1,494.86
| Facility | | $922.91 | $1,295.84 | $1,494.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $724.76 / $1,703.12 / $1,703.12
| Facility | | $724.76 | $1,703.12 | $1,703.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $842.00 / $4,539.00 / $10,113.00
| Facility | | $842.00 | $4,539.00 | $10,113.00 |