- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $907.49 / $1,445.84 / $8,413.00
| Facility | | $907.49 | $1,445.84 | $8,413.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,849.86 / $3,849.86 / $3,906.03
| Facility | | $3,849.86 | $3,849.86 | $3,906.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $606.10 / $606.10 / $14,506.12
| Facility | | $606.10 | $606.10 | $14,506.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $907.49 / $1,109.00 / $1,737.13
| Facility | | $907.49 | $1,109.00 | $1,737.13 |
- 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
- $5,245.68 / $41,843.80 / $47,940.15
| Facility | | $5,245.68 | $41,843.80 | $47,940.15 |