- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $818.45 / $7,968.00 / $13,561.00
| Facility | | $818.45 | $7,968.00 | $13,561.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $606.10 / $606.10 / $1,587.44
| Facility | | $606.10 | $606.10 | $1,587.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $818.45 / $1,010.83 / $1,636.99
| Facility | | $818.45 | $1,010.83 | $1,636.99 |
- 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
- $4,828.92 / $5,864.52 / $26,542.00
| Facility | | $4,828.92 | $5,864.52 | $26,542.00 |