- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $896.00 / $1,278.59 / $10,152.00
| Facility | | $896.00 | $1,278.59 | $10,152.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,320.00 / $4,334.00 / $11,433.00
| Facility | | $2,320.00 | $4,334.00 | $11,433.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,118.73 / $1,526.15 / $1,760.52
| Facility | | $1,118.73 | $1,526.15 | $1,760.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,291.50 / $1,353.71 / $1,353.71
| Facility | | $1,291.50 | $1,353.71 | $1,353.71 |
- 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 |