- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $597.57 / $1,245.00 / $8,413.00
| Facility | | $597.57 | $1,245.00 | $8,413.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $606.10 / $606.10 / $6,025.59
| Facility | | $606.10 | $606.10 | $6,025.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $597.57 / $830.62 / $1,226.36
| Facility | | $597.57 | $830.62 | $1,226.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,206.00 / $6,575.00 / $9,616.00
| Facility | | $2,206.00 | $6,575.00 | $9,616.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,292.92 / $19,913.50 / $26,542.00
| Facility | | $2,292.92 | $19,913.50 | $26,542.00 |