- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $713.14 / $1,021.28 / $7,362.00
| Facility | | $713.14 | $1,021.28 | $7,362.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,787.52 / $2,787.52 / $2,828.19
| Facility | | $2,787.52 | $2,787.52 | $2,828.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $606.10 / $606.10 / $5,302.65
| Facility | | $606.10 | $606.10 | $5,302.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $713.14 / $721.08 / $1,212.33
| Facility | | $713.14 | $721.08 | $1,212.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,015.00 / $15,545.00 / $22,780.00
| Facility | | $4,015.00 | $15,545.00 | $22,780.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $15,295.84 / $17,524.30
| Facility | | $55.00 | $15,295.84 | $17,524.30 |