- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $555.64 / $1,245.00 / $10,453.00
| Facility | | $555.64 | $1,245.00 | $10,453.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $748.70 / $748.70 / $6,025.59
| Facility | | $748.70 | $748.70 | $6,025.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $555.64 / $876.00 / $1,370.66
| Facility | | $555.64 | $876.00 | $1,370.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,317.00 / $14,893.00 / $22,265.00
| Facility | | $4,317.00 | $14,893.00 | $22,265.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,641.88 / $2,893.08 / $26,542.00
| Facility | | $2,641.88 | $2,893.08 | $26,542.00 |