- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $532.53 / $4,148.00 / $7,278.00
| Facility | | $532.53 | $4,148.00 | $7,278.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $530.04 / $530.04 / $2,062.80
| Facility | | $530.04 | $530.04 | $2,062.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $532.53 / $726.09 / $1,108.27
| Facility | | $532.53 | $726.09 | $1,108.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $900.00 / $3,733.00 / $6,543.00
| Facility | | $900.00 | $3,733.00 | $6,543.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,083.70 / $6,817.20 / $16,394.00
| Facility | | $3,083.70 | $6,817.20 | $16,394.00 |