- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $606.46 / $1,615.00 / $8,413.00
| Facility | | $606.46 | $1,615.00 | $8,413.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,066.86 / $3,066.86 / $4,382.17
| Facility | | $3,066.86 | $3,066.86 | $4,382.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $606.10 / $606.10 / $6,025.59
| Facility | | $606.10 | $606.10 | $6,025.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $606.46 / $776.00 / $1,228.19
| Facility | | $606.46 | $776.00 | $1,228.19 |
- 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
- $3,435.72 / $19,913.50 / $26,542.00
| Facility | | $3,435.72 | $19,913.50 | $26,542.00 |