- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $518.78 / $5,724.00 / $10,134.00
| Facility | | $518.78 | $5,724.00 | $10,134.00 |
- 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
- $518.78 / $650.00 / $1,070.19
| Facility | | $518.78 | $650.00 | $1,070.19 |
- 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
- $2,456.55 / $8,957.00 / $26,542.00
| Facility | | $2,456.55 | $8,957.00 | $26,542.00 |