- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $428.03 / $1,410.00 / $12,615.00
| Facility | | $428.03 | $1,410.00 | $12,615.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $852.10 / $852.10 / $2,710.28
| Facility | | $852.10 | $852.10 | $2,710.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $428.03 / $492.23 / $861.52
| Facility | | $428.03 | $492.23 | $861.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,512.67 / $12,081.00 / $18,765.00
| Facility | | $2,512.67 | $12,081.00 | $18,765.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,677.60 / $8,957.00 / $26,542.00
| Facility | | $1,677.60 | $8,957.00 | $26,542.00 |