- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $787.00 / $1,130.44 / $8,229.00
| Facility | | $787.00 | $1,130.44 | $8,229.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,088.00 / $3,889.00 / $8,800.00
| Facility | | $2,088.00 | $3,889.00 | $8,800.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $755.55 / $1,061.83 / $1,213.52
| Facility | | $755.55 | $1,061.83 | $1,213.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $773.66 / $938.76 / $2,049.71
| Facility | | $773.66 | $938.76 | $2,049.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $842.00 / $4,539.00 / $10,966.00
| Facility | | $842.00 | $4,539.00 | $10,966.00 |