- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $591.70 / $1,245.00 / $7,278.00
| Facility | | $591.70 | $1,245.00 | $7,278.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $498.00 / $1,362.98 / $2,709.73
| Facility | | $498.00 | $1,362.98 | $2,709.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $551.00 / $693.85 / $1,077.38
| Facility | | $551.00 | $693.85 | $1,077.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $902.00 / $1,557.00 / $11,999.00
| Facility | | $902.00 | $1,557.00 | $11,999.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,361.62 / $7,929.30 / $16,394.00
| Facility | | $3,361.62 | $7,929.30 | $16,394.00 |