- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $839.97 / $2,145.78 / $7,838.38
| Facility | | $839.97 | $2,145.78 | $7,838.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,224.40 / $7,686.47 / $12,364.60
| Facility | | $2,224.40 | $7,686.47 | $12,364.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $875.00 / $875.00 / $875.00
| Facility | | $875.00 | $875.00 | $875.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $624.74 / $793.55 / $875.00
| Facility | | $624.74 | $793.55 | $875.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $790.00 / $7,773.00 / $13,891.00
| Facility | | $790.00 | $7,773.00 | $13,891.00 |