- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $839.96 / $1,326.00 / $8,413.00
| Facility | | $839.96 | $1,326.00 | $8,413.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $606.10 / $606.10 / $7,941.86
| Facility | | $606.10 | $606.10 | $7,941.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $839.96 / $1,012.73 / $1,618.86
| Facility | | $839.96 | $1,012.73 | $1,618.86 |
- 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
- $3,181.20 / $26,246.45 / $26,542.00
| Facility | | $3,181.20 | $26,246.45 | $26,542.00 |