- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $681.06 / $4,990.56 / $8,413.00
| Facility | | $681.06 | $4,990.56 | $8,413.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $606.10 / $606.10 / $2,710.28
| Facility | | $606.10 | $606.10 | $2,710.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $681.06 / $947.87 / $1,561.38
| Facility | | $681.06 | $947.87 | $1,561.38 |
- 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
- $2,651.44 / $8,957.00 / $26,542.00
| Facility | | $2,651.44 | $8,957.00 | $26,542.00 |