- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $515.17 / $7,439.00 / $11,993.95
| Facility | | $515.17 | $7,439.00 | $11,993.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $852.10 / $852.10 / $6,025.59
| Facility | | $852.10 | $852.10 | $6,025.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $515.17 / $668.48 / $981.67
| Facility | | $515.17 | $668.48 | $981.67 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,661.00 / $7,659.00 / $10,502.00
| Facility | | $1,661.00 | $7,659.00 | $10,502.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,467.45 / $19,913.50 / $26,542.00
| Facility | | $3,467.45 | $19,913.50 | $26,542.00 |