- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $787.00 / $1,006.43 / $8,229.00
| Facility | | $787.00 | $1,006.43 | $8,229.00 |
- 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
- $796.73 / $1,093.55 / $1,261.49
| Facility | | $796.73 | $1,093.55 | $1,261.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $963.26 / $963.26 / $1,200.98
| Facility | | $963.26 | $963.26 | $1,200.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $739.00 / $3,828.00 / $8,582.00
| Facility | | $739.00 | $3,828.00 | $8,582.00 |