- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $458.89 / $1,245.00 / $10,768.00
| Facility | | $458.89 | $1,245.00 | $10,768.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,297.06 / $2,297.06 / $2,330.58
| Facility | | $2,297.06 | $2,297.06 | $2,330.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $606.10 / $606.10 / $2,710.28
| Facility | | $606.10 | $606.10 | $2,710.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $458.89 / $625.22 / $922.82
| Facility | | $458.89 | $625.22 | $922.82 |
- 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
- $2,222.55 / $8,957.00 / $26,542.00
| Facility | | $2,222.55 | $8,957.00 | $26,542.00 |