- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $822.84 / $1,933.00 / $12,247.00
| Facility | | $822.84 | $1,933.00 | $12,247.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,725.95 / $2,998.55 / $5,088.43
| Facility | | $2,725.95 | $2,998.55 | $5,088.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $955.51 / $3,390.19 / $5,654.79
| Facility | | $955.51 | $3,390.19 | $5,654.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $822.84 / $1,140.00 / $1,601.34
| Facility | | $822.84 | $1,140.00 | $1,601.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,461.00 / $2,050.00 / $15,712.00
| Facility | | $1,461.00 | $2,050.00 | $15,712.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,676.39 / $16,547.20 / $26,542.00
| Facility | | $4,676.39 | $16,547.20 | $26,542.00 |