- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $395.94 / $4,061.58 / $7,278.00
| Facility | | $395.94 | $4,061.58 | $7,278.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $530.04 / $530.04 / $1,438.74
| Facility | | $530.04 | $530.04 | $1,438.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $395.94 / $539.40 / $894.82
| Facility | | $395.94 | $539.40 | $894.82 |
- 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
- $1,821.10 / $4,754.80 / $16,394.00
| Facility | | $1,821.10 | $4,754.80 | $16,394.00 |