- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $994.45 / $1,579.73 / $8,413.00
| Facility | | $994.45 | $1,579.73 | $8,413.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,855.05 / $6,855.05 / $6,955.07
| Facility | | $6,855.05 | $6,855.05 | $6,955.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $606.10 / $606.10 / $14,429.51
| Facility | | $606.10 | $606.10 | $14,429.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $994.45 / $1,380.00 / $2,032.26
| Facility | | $994.45 | $1,380.00 | $2,032.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,015.00 / $15,545.00 / $22,780.00
| Facility | | $4,015.00 | $15,545.00 | $22,780.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,715.84 / $41,622.81 / $47,686.95
| Facility | | $5,715.84 | $41,622.81 | $47,686.95 |