- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $698.65 / $1,245.00 / $8,413.00
| Facility | | $698.65 | $1,245.00 | $8,413.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $606.10 / $606.10 / $2,062.80
| Facility | | $606.10 | $606.10 | $2,062.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $698.65 / $998.82 / $1,531.70
| Facility | | $698.65 | $998.82 | $1,531.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $900.00 / $3,733.00 / $6,543.00
| Facility | | $900.00 | $3,733.00 | $6,543.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,629.32 / $6,817.20 / $26,542.00
| Facility | | $2,629.32 | $6,817.20 | $26,542.00 |