- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $715.76 / $1,245.00 / $10,561.00
| Facility | | $715.76 | $1,245.00 | $10,561.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $748.70 / $748.70 / $3,515.41
| Facility | | $748.70 | $748.70 | $3,515.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $715.76 / $908.52 / $1,466.31
| Facility | | $715.76 | $908.52 | $1,466.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,064.00 / $3,456.00 / $5,919.00
| Facility | | $1,064.00 | $3,456.00 | $5,919.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,681.20 / $11,617.80 / $26,542.00
| Facility | | $2,681.20 | $11,617.80 | $26,542.00 |