- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $775.65 / $1,261.25 / $8,413.00
| Facility | | $775.65 | $1,261.25 | $8,413.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $606.10 / $606.10 / $8,701.42
| Facility | | $606.10 | $606.10 | $8,701.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $775.65 / $1,137.00 / $1,737.24
| Facility | | $775.65 | $1,137.00 | $1,737.24 |
- 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
- $2,980.68 / $26,542.00 / $28,756.65
| Facility | | $2,980.68 | $26,542.00 | $28,756.65 |