- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $787.00 / $1,315.04 / $8,229.00
| Facility | | $787.00 | $1,315.04 | $8,229.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,288.00 / $4,261.00 / $11,262.00
| Facility | | $2,288.00 | $4,261.00 | $11,262.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $963.46 / $1,352.64 / $1,545.87
| Facility | | $963.46 | $1,352.64 | $1,545.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,197.86 / $1,197.86 / $3,609.20
| Facility | | $1,197.86 | $1,197.86 | $3,609.20 |
- 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 |