- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $629.87 / $1,615.00 / $10,768.00
| Facility | | $629.87 | $1,615.00 | $10,768.00 |
- 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
- $629.87 / $801.14 / $1,301.25
| Facility | | $629.87 | $801.14 | $1,301.25 |
- 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
- $3,100.75 / $19,913.50 / $26,542.00
| Facility | | $3,100.75 | $19,913.50 | $26,542.00 |