- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $860.00 / $1,272.58 / $9,311.00
| Facility | | $860.00 | $1,272.58 | $9,311.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,088.00 / $3,967.00 / $8,800.00
| Facility | | $2,088.00 | $3,967.00 | $8,800.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,020.62 / $1,400.85 / $1,615.99
| Facility | | $1,020.62 | $1,400.85 | $1,615.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,238.33 / $1,238.33 / $1,238.33
| Facility | | $1,238.33 | $1,238.33 | $1,238.33 |
- 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 |