- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $589.16 / $1,338.00 / $10,768.00
| Facility | | $589.16 | $1,338.00 | $10,768.00 |
- 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
- $589.16 / $806.00 / $1,318.95
| Facility | | $589.16 | $806.00 | $1,318.95 |
- 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
- $3,307.14 / $8,957.00 / $26,542.00
| Facility | | $3,307.14 | $8,957.00 | $26,542.00 |