- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $375.14 / $3,457.50 / $7,278.00
| Facility | | $375.14 | $3,457.50 | $7,278.00 |
- 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
- $530.04 / $530.04 / $1,438.74
| Facility | | $530.04 | $530.04 | $1,438.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $375.14 / $537.29 / $815.73
| Facility | | $375.14 | $537.29 | $815.73 |
- 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
- $1,461.48 / $4,754.80 / $16,394.00
| Facility | | $1,461.48 | $4,754.80 | $16,394.00 |