- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $679.16 / $2,011.28 / $7,993.00
| Facility | | $679.16 | $2,011.28 | $7,993.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,326.31 / $1,326.31 / $1,345.66
| Facility | | $1,326.31 | $1,326.31 | $1,345.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $606.10 / $606.10 / $1,438.74
| Facility | | $606.10 | $606.10 | $1,438.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $679.16 / $868.15 / $1,541.00
| Facility | | $679.16 | $868.15 | $1,541.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $900.00 / $3,733.00 / $6,543.00
| Facility | | $900.00 | $3,733.00 | $6,543.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,527.23 / $4,754.80 / $26,542.00
| Facility | | $2,527.23 | $4,754.80 | $26,542.00 |