- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $734.06 / $6,621.55 / $10,924.00
| Facility | | $734.06 | $6,621.55 | $10,924.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $748.70 / $748.70 / $2,710.28
| Facility | | $748.70 | $748.70 | $2,710.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $582.28 / $700.24 / $1,090.86
| Facility | | $582.28 | $700.24 | $1,090.86 |
- 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
- $2,256.32 / $8,957.00 / $26,542.00
| Facility | | $2,256.32 | $8,957.00 | $26,542.00 |