- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $398.34 / $1,913.49 / $6,575.00
| Facility | | $398.34 | $1,913.49 | $6,575.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,885.13 / $5,631.43 / $11,503.06
| Facility | | $1,885.13 | $5,631.43 | $11,503.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,110.43 / $6,415.31 / $15,432.90
| Facility | | $4,110.43 | $6,415.31 | $15,432.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,677.52 / $5,865.13 / $12,151.89
| Facility | | $3,677.52 | $5,865.13 | $12,151.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $541.11 / $1,912.28 / $5,064.35
| Facility | | $541.11 | $1,912.28 | $5,064.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,121.00 / $5,499.00 / $9,810.00
| Facility | | $3,121.00 | $5,499.00 | $9,810.00 |