- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $548.72 / $7,944.78 / $10,690.00
| Facility | | $548.72 | $7,944.78 | $10,690.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $852.10 / $852.10 / $2,710.28
| Facility | | $852.10 | $852.10 | $2,710.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $548.72 / $756.99 / $1,191.14
| Facility | | $548.72 | $756.99 | $1,191.14 |
- 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
- $2,117.71 / $8,957.00 / $26,542.00
| Facility | | $2,117.71 | $8,957.00 | $26,542.00 |