- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $896.00 / $1,566.77 / $8,229.00
| Facility | | $896.00 | $1,566.77 | $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
- $1,349.86 / $1,896.36 / $2,167.26
| Facility | | $1,349.86 | $1,896.36 | $2,167.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,236.92 / $1,696.33 / $1,728.48
| Facility | | $1,236.92 | $1,696.33 | $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 |