- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $484.35 / $1,773.00 / $5,634.00
| Facility | | $484.35 | $1,773.00 | $5,634.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,682.00 / $3,840.00 / $7,747.00
| Facility | | $1,682.00 | $3,840.00 | $7,747.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $460.57 / $587.00 / $677.31
| Facility | | $460.57 | $587.00 | $677.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,218.40 / $2,218.40 / $2,218.40
| Facility | | $2,218.40 | $2,218.40 | $2,218.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,890.46 / $5,174.00 / $9,243.00
| Facility | | $2,890.46 | $5,174.00 | $9,243.00 |