- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $818.00 / $2,598.00 / $7,365.00
| Facility | | $818.00 | $2,598.00 | $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
- $137.65 / $738.15 / $1,786.32
| Facility | | $137.65 | $738.15 | $1,786.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,216.00 / $2,332.00 / $3,041.00
| Facility | | $1,216.00 | $2,332.00 | $3,041.00 |