- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $649.35 / $1,245.00 / $10,561.00
| Facility | | $649.35 | $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
- $649.35 / $887.00 / $1,305.10
| Facility | | $649.35 | $887.00 | $1,305.10 |
- 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
- $3,782.04 / $8,957.00 / $26,542.00
| Facility | | $3,782.04 | $8,957.00 | $26,542.00 |