- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $851.14 / $1,737.80 / $5,495.41
| Facility | | $851.14 | $1,737.80 | $5,495.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,202.26 / $8,317.64 / $8,317.64
| Facility | | $1,202.26 | $8,317.64 | $8,317.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $851.14 / $1,737.80 / $5,495.41
| Facility | | $851.14 | $1,737.80 | $5,495.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $870.96 / $1,000.00 / $1,513.56
| Facility | | $870.96 | $1,000.00 | $1,513.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $870.96 / $1,023.29 / $1,513.56
| Facility | | $870.96 | $1,023.29 | $1,513.56 |