- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $787.00 / $1,479.57 / $5,320.00
| Facility | | $787.00 | $1,479.57 | $5,320.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,516.00 / $10,990.10 / $30,856.09
| Facility | | $4,516.00 | $10,990.10 | $30,856.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $899.39 / $1,292.44 / $1,490.91
| Facility | | $899.39 | $1,292.44 | $1,490.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,141.83 / $1,141.83 / $1,456.90
| Facility | | $1,141.83 | $1,141.83 | $1,456.90 |
- 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 |