- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $865.33 / $1,388.88 / $12,615.00
| Facility | | $865.33 | $1,388.88 | $12,615.00 |
- 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
- $852.10 / $852.10 / $7,936.15
| Facility | | $852.10 | $852.10 | $7,936.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $865.33 / $1,146.53 / $1,738.60
| Facility | | $865.33 | $1,146.53 | $1,738.60 |
- 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
- $3,353.00 / $26,227.55 / $26,542.00
| Facility | | $3,353.00 | $26,227.55 | $26,542.00 |