- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $831.76 / $3,801.89 / $5,623.41
| Facility | | $831.76 | $3,801.89 | $5,623.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,187.76 / $13,803.84 / $19,054.61
| Facility | | $2,187.76 | $13,803.84 | $19,054.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $562.34 / $616.60 / $707.95
| Facility | | $562.34 | $616.60 | $707.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $588.84 / $1,000.00 / $1,380.38
| Facility | | $588.84 | $1,000.00 | $1,380.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,570.40 / $3,715.35 / $6,456.54
| Facility | | $2,570.40 | $3,715.35 | $6,456.54 |