- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $652.55 / $1,245.00 / $10,561.00
| Facility | | $652.55 | $1,245.00 | $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
- $652.55 / $888.51 / $1,444.85
| Facility | | $652.55 | $888.51 | $1,444.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,629.00 / $9,447.00 / $14,257.00
| Facility | | $2,629.00 | $9,447.00 | $14,257.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,910.38 / $19,913.50 / $26,542.00
| Facility | | $3,910.38 | $19,913.50 | $26,542.00 |