- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $440.04 / $1,245.00 / $8,413.00
| Facility | | $440.04 | $1,245.00 | $8,413.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $606.10 / $606.10 / $1,438.74
| Facility | | $606.10 | $606.10 | $1,438.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $440.04 / $529.47 / $884.51
| Facility | | $440.04 | $529.47 | $884.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $900.00 / $3,733.00 / $6,543.00
| Facility | | $900.00 | $3,733.00 | $6,543.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,716.56 / $4,754.80 / $26,542.00
| Facility | | $1,716.56 | $4,754.80 | $26,542.00 |