- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $787.00 / $1,568.88 / $2,747.00
| Facility | | $787.00 | $1,568.88 | $2,747.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,241.00 / $9,565.00 / $11,253.00
| Facility | | $8,241.00 | $9,565.00 | $11,253.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,380.47 / $1,996.75 / $2,303.39
| Facility | | $1,380.47 | $1,996.75 | $2,303.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,268.73 / $1,748.75 / $1,748.75
| Facility | | $1,268.73 | $1,748.75 | $1,748.75 |
- 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 |