- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $725.14 / $1,245.00 / $10,561.00
| Facility | | $725.14 | $1,245.00 | $10,561.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,503.36 / $2,503.36 / $2,539.89
| Facility | | $2,503.36 | $2,503.36 | $2,539.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $748.70 / $748.70 / $14,429.51
| Facility | | $748.70 | $748.70 | $14,429.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $725.14 / $1,000.12 / $1,469.41
| Facility | | $725.14 | $1,000.12 | $1,469.41 |
- 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
- $4,189.26 / $41,622.81 / $47,686.95
| Facility | | $4,189.26 | $41,622.81 | $47,686.95 |