- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,018.76 / $4,957.64 / $10,453.00
| Facility | | $1,018.76 | $4,957.64 | $10,453.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,311.30 / $1,311.30 / $1,330.43
| Facility | | $1,311.30 | $1,311.30 | $1,330.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $748.70 / $748.70 / $2,062.80
| Facility | | $748.70 | $748.70 | $2,062.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,018.76 / $1,398.00 / $2,219.33
| Facility | | $1,018.76 | $1,398.00 | $2,219.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $900.00 / $3,733.00 / $6,543.00
| Facility | | $900.00 | $3,733.00 | $6,543.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,868.35 / $6,817.20 / $26,542.00
| Facility | | $4,868.35 | $6,817.20 | $26,542.00 |