- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $565.58 / $1,245.00 / $8,413.00
| Facility | | $565.58 | $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
- $565.58 / $741.64 / $1,181.71
| Facility | | $565.58 | $741.64 | $1,181.71 |
- 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
- $2,695.20 / $8,957.00 / $26,542.00
| Facility | | $2,695.20 | $8,957.00 | $26,542.00 |