- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $477.08 / $1,615.00 / $10,561.00
| Facility | | $477.08 | $1,615.00 | $10,561.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,503.36 / $2,503.36 / $2,539.89
| Facility | | $2,503.36 | $2,503.36 | $2,539.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $748.70 / $748.70 / $2,710.28
| Facility | | $748.70 | $748.70 | $2,710.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $477.08 / $699.11 / $1,078.20
| Facility | | $477.08 | $699.11 | $1,078.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,248.00 / $9,541.00 / $14,589.00
| Facility | | $2,248.00 | $9,541.00 | $14,589.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,853.96 / $8,957.00 / $26,542.00
| Facility | | $1,853.96 | $8,957.00 | $26,542.00 |