- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $591.22 / $4,001.00 / $8,442.00
| Facility | | $591.22 | $4,001.00 | $8,442.00 |
- 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 / $2,710.28
| Facility | | $748.70 | $748.70 | $2,710.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $591.22 / $862.97 / $1,310.15
| Facility | | $591.22 | $862.97 | $1,310.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,470.62 / $9,447.00 / $14,257.00
| Facility | | $2,470.62 | $9,447.00 | $14,257.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,294.04 / $8,957.00 / $26,542.00
| Facility | | $2,294.04 | $8,957.00 | $26,542.00 |