- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $802.71 / $1,340.83 / $8,413.00
| Facility | | $802.71 | $1,340.83 | $8,413.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,503.36 / $2,503.36 / $2,539.89
| Facility | | $2,503.36 | $2,503.36 | $2,539.89 |
- 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
- $802.71 / $1,039.44 / $1,664.04
| Facility | | $802.71 | $1,039.44 | $1,664.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,629.00 / $8,549.00 / $13,997.00
| Facility | | $2,629.00 | $8,549.00 | $13,997.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,066.40 / $8,957.00 / $26,542.00
| Facility | | $3,066.40 | $8,957.00 | $26,542.00 |