- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $598.28 / $598.28 / $3,550.00
| Facility | | $598.28 | $598.28 | $3,550.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $604.85 / $751.01 / $1,654.96
| Facility | | $604.85 | $751.01 | $1,654.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $649.19 / $649.19 / $649.19
| Facility | | $649.19 | $649.19 | $649.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,351.51 / $10,351.51 / $10,351.51
| Facility | | $10,351.51 | $10,351.51 | $10,351.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $21,274.50 / $21,274.50 / $21,274.50
| Facility | | $21,274.50 | $21,274.50 | $21,274.50 |