- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $860.00 / $1,491.86 / $8,229.00
| Facility | | $860.00 | $1,491.86 | $8,229.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,830.00 / $8,584.00 / $11,253.00
| Facility | | $5,830.00 | $8,584.00 | $11,253.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,280.84 / $1,800.83 / $2,058.10
| Facility | | $1,280.84 | $1,800.83 | $2,058.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,055.63 / $1,613.94 / $1,728.48
| Facility | | $1,055.63 | $1,613.94 | $1,728.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $739.00 / $3,828.00 / $8,582.00
| Facility | | $739.00 | $3,828.00 | $8,582.00 |