- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $442.08 / $5,867.10 / $7,278.00
| Facility | | $442.08 | $5,867.10 | $7,278.00 |
- 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
- $530.04 / $530.04 / $2,710.28
| Facility | | $530.04 | $530.04 | $2,710.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $442.08 / $578.46 / $885.63
| Facility | | $442.08 | $578.46 | $885.63 |
- 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
- $1,714.56 / $8,957.00 / $16,394.00
| Facility | | $1,714.56 | $8,957.00 | $16,394.00 |