- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $578.60 / $1,020.00 / $7,968.00
| Facility | | $578.60 | $1,020.00 | $7,968.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $515.00 / $2,844.33 / $5,654.79
| Facility | | $515.00 | $2,844.33 | $5,654.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $536.62 / $694.32 / $1,048.61
| Facility | | $536.62 | $694.32 | $1,048.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $773.00 / $1,208.00 / $9,324.00
| Facility | | $773.00 | $1,208.00 | $9,324.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,241.56 / $16,547.20 / $26,542.00
| Facility | | $3,241.56 | $16,547.20 | $26,542.00 |