- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $471.07 / $1,824.96 / $7,993.00
| Facility | | $471.07 | $1,824.96 | $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
- $438.31 / $578.54 / $878.35
| Facility | | $438.31 | $578.54 | $878.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,661.00 / $7,659.00 / $10,502.00
| Facility | | $1,661.00 | $7,659.00 | $10,502.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,642.96 / $8,957.00 / $26,542.00
| Facility | | $1,642.96 | $8,957.00 | $26,542.00 |