- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $787.00 / $1,361.53 / $2,747.00
| Facility | | $787.00 | $1,361.53 | $2,747.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,643.00 / $3,498.00 / $8,517.00
| Facility | | $1,643.00 | $3,498.00 | $8,517.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,160.13 / $1,650.25 / $1,903.69
| Facility | | $1,160.13 | $1,650.25 | $1,903.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,345.74 / $1,474.87 / $1,474.87
| Facility | | $1,345.74 | $1,474.87 | $1,474.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $739.00 / $3,828.00 / $8,582.00
| Facility | | $739.00 | $3,828.00 | $8,582.00 |