- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $948.55 / $3,682.00 / $13,004.00
| Facility | | $948.55 | $3,682.00 | $13,004.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,027.02 / $1,027.02 / $1,027.02
| Facility | | $1,027.02 | $1,027.02 | $1,027.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $55.00 / $15,460.68
| Facility | | $55.00 | $55.00 | $15,460.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,082.60 / $1,431.30 / $2,534.29
| Facility | | $1,082.60 | $1,431.30 | $2,534.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,082.60 / $1,438.97 / $2,692.36
| Facility | | $1,082.60 | $1,438.97 | $2,692.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $385.00 / $2,064.00 / $8,759.00
| Facility | | $385.00 | $2,064.00 | $8,759.00 |