- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $787.00 / $1,486.00 / $5,320.00
| Facility | | $787.00 | $1,486.00 | $5,320.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,258.00 / $2,316.00 / $4,389.00
| Facility | | $1,258.00 | $2,316.00 | $4,389.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $886.23 / $1,215.52 / $1,402.20
| Facility | | $886.23 | $1,215.52 | $1,402.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $988.14 / $1,065.54 / $1,065.54
| Facility | | $988.14 | $1,065.54 | $1,065.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $842.00 / $4,539.00 / $10,113.00
| Facility | | $842.00 | $4,539.00 | $10,113.00 |