- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $790.64 / $1,159.73 / $10,561.00
| Facility | | $790.64 | $1,159.73 | $10,561.00 |
- 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
- $748.70 / $748.70 / $2,710.28
| Facility | | $748.70 | $748.70 | $2,710.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $790.64 / $1,017.48 / $1,637.33
| Facility | | $790.64 | $1,017.48 | $1,637.33 |
- 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
- $2,973.08 / $8,957.00 / $26,542.00
| Facility | | $2,973.08 | $8,957.00 | $26,542.00 |