- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $418.73 / $937.57 / $7,968.00
| Facility | | $418.73 | $937.57 | $7,968.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $606.10 / $606.10 / $8,120.72
| Facility | | $606.10 | $606.10 | $8,120.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $425.24 / $727.79 / $1,079.34
| Facility | | $425.24 | $727.79 | $1,079.34 |
- 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
- $2,003.56 / $2,192.32 / $26,542.00
| Facility | | $2,003.56 | $2,192.32 | $26,542.00 |