- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $787.00 / $988.00 / $3,740.00
| Facility | | $787.00 | $988.00 | $3,740.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,289.81 / $4,961.39 / $11,253.00
| Facility | | $2,289.81 | $4,961.39 | $11,253.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $858.85 / $1,239.27 / $1,549.08
| Facility | | $858.85 | $1,239.27 | $1,549.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,047.06 / $1,084.33 / $1,084.33
| Facility | | $1,047.06 | $1,084.33 | $1,084.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $523.00 / $1,450.00 / $5,301.00
| Facility | | $523.00 | $1,450.00 | $5,301.00 |