- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $787.00 / $1,270.06 / $2,747.00
| Facility | | $787.00 | $1,270.06 | $2,747.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,830.00 / $8,584.00 / $11,253.00
| Facility | | $5,830.00 | $8,584.00 | $11,253.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,114.42 / $1,616.44 / $1,864.68
| Facility | | $1,114.42 | $1,616.44 | $1,864.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,429.96 / $1,429.96 / $1,429.96
| Facility | | $1,429.96 | $1,429.96 | $1,429.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $599.00 / $2,723.00 / $6,295.00
| Facility | | $599.00 | $2,723.00 | $6,295.00 |