- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $573.16 / $1,615.00 / $10,768.00
| Facility | | $573.16 | $1,615.00 | $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
- $573.16 / $694.67 / $1,317.40
| Facility | | $573.16 | $694.67 | $1,317.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,629.00 / $8,549.00 / $13,997.00
| Facility | | $2,629.00 | $8,549.00 | $13,997.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,213.71 / $8,957.00 / $26,542.00
| Facility | | $2,213.71 | $8,957.00 | $26,542.00 |