- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $787.00 / $1,150.64 / $8,229.00
| Facility | | $787.00 | $1,150.64 | $8,229.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,014.00 / $8,584.00 / $11,253.00
| Facility | | $4,014.00 | $8,584.00 | $11,253.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $883.38 / $1,212.48 / $1,398.69
| Facility | | $883.38 | $1,212.48 | $1,398.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,061.77 / $1,061.77 / $1,061.77
| Facility | | $1,061.77 | $1,061.77 | $1,061.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $631.00 / $1,121.00 / $8,582.00
| Facility | | $631.00 | $1,121.00 | $8,582.00 |