- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $396.33 / $3,996.50 / $7,993.00
| Facility | | $396.33 | $3,996.50 | $7,993.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $606.10 / $606.10 / $2,710.28
| Facility | | $606.10 | $606.10 | $2,710.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $396.33 / $556.02 / $861.54
| Facility | | $396.33 | $556.02 | $861.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,711.00 / $7,162.00 / $10,397.00
| Facility | | $1,711.00 | $7,162.00 | $10,397.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,500.08 / $8,957.00 / $26,542.00
| Facility | | $1,500.08 | $8,957.00 | $26,542.00 |