- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $837.78 / $1,384.80 / $8,413.00
| Facility | | $837.78 | $1,384.80 | $8,413.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $606.10 / $606.10 / $5,302.65
| Facility | | $606.10 | $606.10 | $5,302.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $837.78 / $1,084.33 / $1,747.85
| Facility | | $837.78 | $1,084.33 | $1,747.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,183.00 / $12,216.00 / $19,066.00
| Facility | | $3,183.00 | $12,216.00 | $19,066.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,787.88 / $17,524.30 / $26,542.00
| Facility | | $4,787.88 | $17,524.30 | $26,542.00 |