- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $787.00 / $1,734.40 / $8,229.00
| Facility | | $787.00 | $1,734.40 | $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
- $900.54 / $1,236.03 / $1,425.86
| Facility | | $900.54 | $1,236.03 | $1,425.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,083.76 / $1,083.76 / $1,083.76
| Facility | | $1,083.76 | $1,083.76 | $1,083.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $631.00 / $1,121.00 / $19,776.00
| Facility | | $631.00 | $1,121.00 | $19,776.00 |