- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $653.77 / $5,724.00 / $8,646.95
| Facility | | $653.77 | $5,724.00 | $8,646.95 |
- 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
- $653.77 / $896.11 / $1,192.03
| Facility | | $653.77 | $896.11 | $1,192.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,661.00 / $7,659.00 / $10,502.00
| Facility | | $1,661.00 | $7,659.00 | $10,502.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,538.16 / $8,957.00 / $26,542.00
| Facility | | $2,538.16 | $8,957.00 | $26,542.00 |