- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $778.62 / $2,234.46 / $10,453.00
| Facility | | $778.62 | $2,234.46 | $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
- $778.62 / $1,009.09 / $1,708.49
| Facility | | $778.62 | $1,009.09 | $1,708.49 |
- 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
- $2,900.72 / $8,957.00 / $26,542.00
| Facility | | $2,900.72 | $8,957.00 | $26,542.00 |