- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $539.19 / $2,048.78 / $7,968.00
| Facility | | $539.19 | $2,048.78 | $7,968.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $530.04 / $530.04 / $7,742.24
| Facility | | $530.04 | $530.04 | $7,742.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $539.19 / $819.02 / $1,218.57
| Facility | | $539.19 | $819.02 | $1,218.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,629.00 / $9,447.00 / $14,257.00
| Facility | | $2,629.00 | $9,447.00 | $14,257.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,050.52 / $22,332.98 / $25,586.75
| Facility | | $2,050.52 | $22,332.98 | $25,586.75 |