- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $648.51 / $5,611.88 / $8,413.00
| Facility | | $648.51 | $5,611.88 | $8,413.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $606.10 / $606.10 / $7,943.43
| Facility | | $606.10 | $606.10 | $7,943.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $648.51 / $1,004.00 / $1,465.63
| Facility | | $648.51 | $1,004.00 | $1,465.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,183.00 / $12,216.00 / $19,066.00
| Facility | | $3,183.00 | $12,216.00 | $19,066.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,734.34 / $26,251.60 / $26,542.00
| Facility | | $3,734.34 | $26,251.60 | $26,542.00 |