- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $815.35 / $3,625.88 / $7,278.00
| Facility | | $815.35 | $3,625.88 | $7,278.00 |
- 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
- $530.04 / $530.04 / $2,710.28
| Facility | | $530.04 | $530.04 | $2,710.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $815.35 / $1,214.70 / $1,959.00
| Facility | | $815.35 | $1,214.70 | $1,959.00 |
- 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
- $3,869.30 / $8,957.00 / $16,394.00
| Facility | | $3,869.30 | $8,957.00 | $16,394.00 |