- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $660.83 / $1,338.00 / $8,413.00
| Facility | | $660.83 | $1,338.00 | $8,413.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,397.92 / $4,397.92 / $6,284.08
| Facility | | $4,397.92 | $4,397.92 | $6,284.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $606.10 / $606.10 / $8,130.59
| Facility | | $606.10 | $606.10 | $8,130.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $660.83 / $808.86 / $1,291.56
| Facility | | $660.83 | $808.86 | $1,291.56 |
- 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
- $2,559.32 / $26,542.00 / $26,870.15
| Facility | | $2,559.32 | $26,542.00 | $26,870.15 |