- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $909.59 / $6,384.00 / $8,748.09
| Facility | | $909.59 | $6,384.00 | $8,748.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $515.00 / $1,362.98 / $2,709.73
| Facility | | $515.00 | $1,362.98 | $2,709.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $475.52 / $581.71 / $912.81
| Facility | | $475.52 | $581.71 | $912.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,180.42 / $7,180.42 / $7,180.42
| Facility | | $7,180.42 | $7,180.42 | $7,180.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $773.00 / $1,208.00 / $9,324.00
| Facility | | $773.00 | $1,208.00 | $9,324.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,704.86 / $7,929.30 / $26,542.00
| Facility | | $2,704.86 | $7,929.30 | $26,542.00 |