- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $818.00 / $2,507.00 / $7,365.00
| Facility | | $818.00 | $2,507.00 | $7,365.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $862.00 / $1,785.00 / $4,773.00
| Facility | | $862.00 | $1,785.00 | $4,773.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,652.00 / $1,652.00 / $1,652.00
| Facility | | $1,652.00 | $1,652.00 | $1,652.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $397.94 / $626.66 / $1,497.40
| Facility | | $397.94 | $626.66 | $1,497.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,380.00 / $2,332.00 / $3,041.00
| Facility | | $1,380.00 | $2,332.00 | $3,041.00 |