- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $611.37 / $5,386.77 / $14,528.00
| Facility | | $611.37 | $5,386.77 | $14,528.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,015.30 / $2,015.30 / $2,044.70
| Facility | | $2,015.30 | $2,015.30 | $2,044.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,182.48 / $1,182.48 / $2,710.28
| Facility | | $1,182.48 | $1,182.48 | $2,710.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $465.40 / $610.51 / $933.99
| Facility | | $465.40 | $610.51 | $933.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,661.00 / $7,659.00 / $10,502.00
| Facility | | $1,661.00 | $7,659.00 | $10,502.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,806.96 / $8,957.00 / $26,542.00
| Facility | | $1,806.96 | $8,957.00 | $26,542.00 |