- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $761.65 / $6,645.13 / $7,993.00
| Facility | | $761.65 | $6,645.13 | $7,993.00 |
- 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
- $567.70 / $817.51 / $1,228.93
| Facility | | $567.70 | $817.51 | $1,228.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,248.00 / $9,541.00 / $14,589.00
| Facility | | $2,248.00 | $9,541.00 | $14,589.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,709.40 / $8,957.00 / $26,542.00
| Facility | | $2,709.40 | $8,957.00 | $26,542.00 |