- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $645.65 / $2,818.38 / $10,471.29
| Facility | | $645.65 | $2,818.38 | $10,471.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,884.03 / $4,466.84 / $12,022.64
| Facility | | $2,884.03 | $4,466.84 | $12,022.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $562.34 / $776.25 / $1,000.00
| Facility | | $562.34 | $776.25 | $1,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,047.13 / $1,047.13 / $2,511.89
| Facility | | $1,047.13 | $1,047.13 | $2,511.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $851.14 / $4,677.35 / $10,000.00
| Facility | | $851.14 | $4,677.35 | $10,000.00 |