- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $493.66 / $4,829.82 / $7,724.00
| Facility | | $493.66 | $4,829.82 | $7,724.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,863.39 / $1,863.39 / $2,662.55
| Facility | | $1,863.39 | $1,863.39 | $2,662.55 |
- 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
- $493.66 / $770.10 / $1,237.17
| Facility | | $493.66 | $770.10 | $1,237.17 |
- 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
- $1,913.96 / $8,957.00 / $26,542.00
| Facility | | $1,913.96 | $8,957.00 | $26,542.00 |