- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $787.00 / $946.40 / $8,229.00
| Facility | | $787.00 | $946.40 | $8,229.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,643.00 / $3,498.00 / $8,517.00
| Facility | | $1,643.00 | $3,498.00 | $8,517.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $859.07 / $1,179.10 / $1,360.19
| Facility | | $859.07 | $1,179.10 | $1,360.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,037.58 / $1,037.58 / $1,037.58
| Facility | | $1,037.58 | $1,037.58 | $1,037.58 |
- 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 |