- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $754.35 / $1,245.00 / $8,413.00
| Facility | | $754.35 | $1,245.00 | $8,413.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,226.87 / $2,226.87 / $2,259.36
| Facility | | $2,226.87 | $2,226.87 | $2,259.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $606.10 / $606.10 / $2,710.28
| Facility | | $606.10 | $606.10 | $2,710.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $754.35 / $972.45 / $1,496.65
| Facility | | $754.35 | $972.45 | $1,496.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,347.00 / $8,736.00 / $13,997.00
| Facility | | $3,347.00 | $8,736.00 | $13,997.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,834.04 / $8,957.00 / $26,542.00
| Facility | | $2,834.04 | $8,957.00 | $26,542.00 |