- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $931.05 / $2,536.00 / $13,623.15
| Facility | | $931.05 | $2,536.00 | $13,623.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,736.14 / $5,736.14 / $8,196.23
| Facility | | $5,736.14 | $5,736.14 | $8,196.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,182.48 / $1,182.48 / $14,913.76
| Facility | | $1,182.48 | $1,182.48 | $14,913.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $931.05 / $1,312.22 / $2,040.46
| Facility | | $931.05 | $1,312.22 | $2,040.46 |
- 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
- $5,357.88 / $43,019.65 / $49,287.30
| Facility | | $5,357.88 | $43,019.65 | $49,287.30 |