- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $647.72 / $4,824.00 / $10,561.00
| Facility | | $647.72 | $4,824.00 | $10,561.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $748.70 / $748.70 / $6,025.59
| Facility | | $748.70 | $748.70 | $6,025.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $647.72 / $906.81 / $1,326.78
| Facility | | $647.72 | $906.81 | $1,326.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,248.00 / $9,541.00 / $14,589.00
| Facility | | $2,248.00 | $9,541.00 | $14,589.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,763.56 / $19,913.50 / $26,542.00
| Facility | | $3,763.56 | $19,913.50 | $26,542.00 |