- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $522.91 / $1,475.48 / $7,968.00
| Facility | | $522.91 | $1,475.48 | $7,968.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,703.55 / $1,703.55 / $1,728.40
| Facility | | $1,703.55 | $1,703.55 | $1,728.40 |
- 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
- $522.91 / $668.00 / $1,044.86
| Facility | | $522.91 | $668.00 | $1,044.86 |
- 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
- $2,532.44 / $8,957.00 / $26,542.00
| Facility | | $2,532.44 | $8,957.00 | $26,542.00 |