- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $464.36 / $5,159.97 / $10,453.00
| Facility | | $464.36 | $5,159.97 | $10,453.00 |
- 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
- $464.36 / $589.00 / $938.20
| Facility | | $464.36 | $589.00 | $938.20 |
- 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
- $2,275.10 / $8,957.00 / $26,542.00
| Facility | | $2,275.10 | $8,957.00 | $26,542.00 |