- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $901.00 / $3,688.37 / $9,958.12
| Facility | | $901.00 | $3,688.37 | $9,958.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $453.24 / $1,828.86 / $3,635.94
| Facility | | $453.24 | $1,828.86 | $3,635.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $349.36 / $556.67 / $924.05
| Facility | | $349.36 | $556.67 | $924.05 |
- 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
- $2,257.71 / $10,639.60 / $16,394.00
| Facility | | $2,257.71 | $10,639.60 | $16,394.00 |