- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $445.56 / $1,338.00 / $10,768.00
| Facility | | $445.56 | $1,338.00 | $10,768.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $606.10 / $606.10 / $2,710.28
| Facility | | $606.10 | $606.10 | $2,710.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $445.56 / $554.00 / $913.34
| Facility | | $445.56 | $554.00 | $913.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,015.00 / $15,545.00 / $22,780.00
| Facility | | $4,015.00 | $15,545.00 | $22,780.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,736.04 / $8,957.00 / $26,542.00
| Facility | | $1,736.04 | $8,957.00 | $26,542.00 |