- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $689.75 / $1,095.71 / $8,413.00
| Facility | | $689.75 | $1,095.71 | $8,413.00 |
- 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
- $689.75 / $988.98 / $1,558.84
| Facility | | $689.75 | $988.98 | $1,558.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,470.62 / $9,447.00 / $14,257.00
| Facility | | $2,470.62 | $9,447.00 | $14,257.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,981.66 / $8,957.00 / $26,542.00
| Facility | | $3,981.66 | $8,957.00 | $26,542.00 |