- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $860.00 / $1,366.88 / $9,311.00
| Facility | | $860.00 | $1,366.88 | $9,311.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,755.00 / $8,584.00 / $11,253.00
| Facility | | $4,755.00 | $8,584.00 | $11,253.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,267.48 / $1,739.67 / $2,006.84
| Facility | | $1,267.48 | $1,739.67 | $2,006.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,264.80 / $1,528.61 / $1,528.61
| Facility | | $1,264.80 | $1,528.61 | $1,528.61 |
- 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 |