- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $975.88 / $6,735.00 / $8,413.00
| Facility | | $975.88 | $6,735.00 | $8,413.00 |
- 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
- $970.47 / $1,262.58 / $1,985.54
| Facility | | $970.47 | $1,262.58 | $1,985.54 |
- 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
- $3,679.08 / $8,957.00 / $26,542.00
| Facility | | $3,679.08 | $8,957.00 | $26,542.00 |