- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $491.57 / $3,264.62 / $7,968.00
| Facility | | $491.57 | $3,264.62 | $7,968.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,686.35 / $1,686.35 / $2,409.59
| Facility | | $1,686.35 | $1,686.35 | $2,409.59 |
- 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
- $472.52 / $589.88 / $896.36
| Facility | | $472.52 | $589.88 | $896.36 |
- 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
- $1,913.88 / $8,957.00 / $26,542.00
| Facility | | $1,913.88 | $8,957.00 | $26,542.00 |