- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $595.87 / $950.51 / $8,413.00
| Facility | | $595.87 | $950.51 | $8,413.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $606.10 / $606.10 / $6,025.59
| Facility | | $606.10 | $606.10 | $6,025.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $595.87 / $853.00 / $1,260.51
| Facility | | $595.87 | $853.00 | $1,260.51 |
- 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
- $2,290.48 / $19,913.50 / $26,542.00
| Facility | | $2,290.48 | $19,913.50 | $26,542.00 |