- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $358.12 / $1,687.02 / $7,278.00
| Facility | | $358.12 | $1,687.02 | $7,278.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $530.04 / $530.04 / $2,062.80
| Facility | | $530.04 | $530.04 | $2,062.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $358.12 / $482.30 / $809.35
| Facility | | $358.12 | $482.30 | $809.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,661.00 / $7,659.00 / $10,502.00
| Facility | | $1,661.00 | $7,659.00 | $10,502.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,411.52 / $6,817.20 / $16,394.00
| Facility | | $1,411.52 | $6,817.20 | $16,394.00 |