- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $734.59 / $4,683.27 / $15,291.00
| Facility | | $734.59 | $4,683.27 | $15,291.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,474.86 / $3,474.86 / $3,525.56
| Facility | | $3,474.86 | $3,474.86 | $3,525.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,182.48 / $1,182.48 / $5,006.99
| Facility | | $1,182.48 | $1,182.48 | $5,006.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $734.59 / $1,013.00 / $1,547.14
| Facility | | $734.59 | $1,013.00 | $1,547.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,183.00 / $12,216.00 / $19,066.00
| Facility | | $3,183.00 | $12,216.00 | $19,066.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,848.83 / $16,547.20 / $26,542.00
| Facility | | $4,848.83 | $16,547.20 | $26,542.00 |