- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $860.00 / $1,285.01 / $8,229.00
| Facility | | $860.00 | $1,285.01 | $8,229.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,212.00 / $9,015.00 / $11,253.00
| Facility | | $7,212.00 | $9,015.00 | $11,253.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $957.48 / $1,305.84 / $1,506.40
| Facility | | $957.48 | $1,305.84 | $1,506.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,140.36 / $1,140.36 / $1,533.41
| Facility | | $1,140.36 | $1,140.36 | $1,533.41 |
- 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 |