- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $860.00 / $1,584.67 / $8,229.00
| Facility | | $860.00 | $1,584.67 | $8,229.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,088.00 / $3,967.00 / $9,461.00
| Facility | | $2,088.00 | $3,967.00 | $9,461.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,105.31 / $1,586.02 / $1,829.59
| Facility | | $1,105.31 | $1,586.02 | $1,829.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,390.72 / $1,390.72 / $1,560.40
| Facility | | $1,390.72 | $1,390.72 | $1,560.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $973.00 / $4,639.00 / $12,296.00
| Facility | | $973.00 | $4,639.00 | $12,296.00 |