- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $651.05 / $4,673.00 / $9,870.00
| Facility | | $651.05 | $4,673.00 | $9,870.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $968.00 / $4,404.33 / $11,671.67
| Facility | | $968.00 | $4,404.33 | $11,671.67 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $375.00 / $622.54 / $3,845.77
| Facility | | $375.00 | $622.54 | $3,845.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $553.40 / $763.04 / $1,106.80
| Facility | | $553.40 | $763.04 | $1,106.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $710.00 / $10,069.00 / $16,249.00
| Facility | | $710.00 | $10,069.00 | $16,249.00 |