- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $516.87 / $2,675.00 / $8,413.00
| Facility | | $516.87 | $2,675.00 | $8,413.00 |
- 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
- $516.87 / $731.43 / $1,437.00
| Facility | | $516.87 | $731.43 | $1,437.00 |
- 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
- $2,000.40 / $8,957.00 / $26,542.00
| Facility | | $2,000.40 | $8,957.00 | $26,542.00 |