- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $630.34 / $1,245.00 / $10,561.00
| Facility | | $630.34 | $1,245.00 | $10,561.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $748.70 / $748.70 / $2,710.28
| Facility | | $748.70 | $748.70 | $2,710.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $546.00 / $756.41 / $1,267.94
| Facility | | $546.00 | $756.41 | $1,267.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,661.00 / $7,659.00 / $10,502.00
| Facility | | $1,661.00 | $7,659.00 | $10,502.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,522.96 / $8,957.00 / $26,542.00
| Facility | | $3,522.96 | $8,957.00 | $26,542.00 |