- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $731.19 / $1,245.00 / $9,242.37
| Facility | | $731.19 | $1,245.00 | $9,242.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $530.04 / $530.04 / $6,025.59
| Facility | | $530.04 | $530.04 | $6,025.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $731.19 / $1,078.51 / $1,584.56
| Facility | | $731.19 | $1,078.51 | $1,584.56 |
- 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
- $4,137.54 / $17,381.18 / $19,945.84
| Facility | | $4,137.54 | $17,381.18 | $19,945.84 |