- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $446.76 / $1,245.00 / $8,413.00
| Facility | | $446.76 | $1,245.00 | $8,413.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $606.10 / $606.10 / $1,438.74
| Facility | | $606.10 | $606.10 | $1,438.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $427.05 / $536.11 / $882.28
| Facility | | $427.05 | $536.11 | $882.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $900.00 / $3,733.00 / $6,543.00
| Facility | | $900.00 | $3,733.00 | $6,543.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,676.56 / $4,754.80 / $26,542.00
| Facility | | $1,676.56 | $4,754.80 | $26,542.00 |