- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $444.47 / $1,615.00 / $15,291.00
| Facility | | $444.47 | $1,615.00 | $15,291.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,182.48 / $1,182.48 / $2,710.28
| Facility | | $1,182.48 | $1,182.48 | $2,710.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $444.47 / $608.51 / $1,093.92
| Facility | | $444.47 | $608.51 | $1,093.92 |
- 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
- $2,160.05 / $8,957.00 / $26,542.00
| Facility | | $2,160.05 | $8,957.00 | $26,542.00 |