- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $724.04 / $1,245.00 / $10,561.00
| Facility | | $724.04 | $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
- $724.04 / $1,022.39 / $1,552.18
| Facility | | $724.04 | $1,022.39 | $1,552.18 |
- 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
- $4,182.06 / $19,913.50 / $26,542.00
| Facility | | $4,182.06 | $19,913.50 | $26,542.00 |