- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $787.00 / $1,466.62 / $2,747.00
| Facility | | $787.00 | $1,466.62 | $2,747.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,830.00 / $8,584.00 / $11,253.00
| Facility | | $5,830.00 | $8,584.00 | $11,253.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,282.85 / $1,866.61 / $2,153.27
| Facility | | $1,282.85 | $1,866.61 | $2,153.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,629.96 / $1,629.96 / $1,629.96
| Facility | | $1,629.96 | $1,629.96 | $1,629.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $599.00 / $2,723.00 / $6,295.00
| Facility | | $599.00 | $2,723.00 | $6,295.00 |