- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $497.08 / $1,245.00 / $8,413.00
| Facility | | $497.08 | $1,245.00 | $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
- $497.08 / $646.63 / $1,015.56
| Facility | | $497.08 | $646.63 | $1,015.56 |
- 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
- $2,359.80 / $8,957.00 / $26,542.00
| Facility | | $2,359.80 | $8,957.00 | $26,542.00 |