- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $787.00 / $1,201.88 / $2,747.00
| Facility | | $787.00 | $1,201.88 | $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
- $883.35 / $1,251.54 / $1,443.75
| Facility | | $883.35 | $1,251.54 | $1,443.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,121.08 / $1,121.08 / $1,183.48
| Facility | | $1,121.08 | $1,121.08 | $1,183.48 |
- 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 |