- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $494.30 / $2,997.00 / $10,134.00
| Facility | | $494.30 | $2,997.00 | $10,134.00 |
- 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
- $494.30 / $712.64 / $1,117.11
| Facility | | $494.30 | $712.64 | $1,117.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,470.62 / $9,447.00 / $14,257.00
| Facility | | $2,470.62 | $9,447.00 | $14,257.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,897.84 / $8,957.00 / $26,542.00
| Facility | | $1,897.84 | $8,957.00 | $26,542.00 |