- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $462.94 / $1,615.00 / $7,968.00
| Facility | | $462.94 | $1,615.00 | $7,968.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,226.87 / $2,226.87 / $2,259.36
| Facility | | $2,226.87 | $2,226.87 | $2,259.36 |
- 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
- $462.94 / $558.04 / $1,046.24
| Facility | | $462.94 | $558.04 | $1,046.24 |
- 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
- $1,798.64 / $8,957.00 / $26,542.00
| Facility | | $1,798.64 | $8,957.00 | $26,542.00 |