- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $764.83 / $1,245.00 / $10,561.00
| Facility | | $764.83 | $1,245.00 | $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 / $6,025.59
| Facility | | $748.70 | $748.70 | $6,025.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $764.83 / $971.33 / $1,586.23
| Facility | | $764.83 | $971.33 | $1,586.23 |
- 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
- $2,867.76 / $19,913.50 / $26,542.00
| Facility | | $2,867.76 | $19,913.50 | $26,542.00 |