- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $494.95 / $1,386.00 / $11,093.00
| Facility | | $494.95 | $1,386.00 | $11,093.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,153.00 / $5,757.57 / $8,388.00
| Facility | | $1,153.00 | $5,757.57 | $8,388.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $463.23 / $590.40 / $681.23
| Facility | | $463.23 | $590.40 | $681.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,243.79 / $2,243.79 / $2,243.79
| Facility | | $2,243.79 | $2,243.79 | $2,243.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,364.00 / $6,094.00 / $10,413.00
| Facility | | $3,364.00 | $6,094.00 | $10,413.00 |