- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $841.53 / $841.53 / $2,300.00
| Facility | | $841.53 | $841.53 | $2,300.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $865.67 / $941.95 / $1,026.27
| Facility | | $865.67 | $941.95 | $1,026.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $934.45 / $934.45 / $934.45
| Facility | | $934.45 | $934.45 | $934.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,349.73 / $8,349.73 / $8,349.73
| Facility | | $8,349.73 | $8,349.73 | $8,349.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,450.00 / $2,450.00 / $2,450.00
| Facility | | $2,450.00 | $2,450.00 | $2,450.00 |