- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $503.61 / $1,338.00 / $10,134.00
| Facility | | $503.61 | $1,338.00 | $10,134.00 |
- 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
- $503.61 / $705.67 / $1,033.00
| Facility | | $503.61 | $705.67 | $1,033.00 |
- 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
- $2,435.40 / $8,957.00 / $33,500.00
| Facility | | $2,435.40 | $8,957.00 | $33,500.00 |