- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $583.32 / $3,860.00 / $7,762.66
| Facility | | $583.32 | $3,860.00 | $7,762.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,648.16 / $5,939.08 / $11,966.76
| Facility | | $2,648.16 | $5,939.08 | $11,966.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,424.38 / $2,020.98 / $4,861.75
| Facility | | $1,424.38 | $2,020.98 | $4,861.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,294.89 / $1,847.66 / $3,828.15
| Facility | | $1,294.89 | $1,847.66 | $3,828.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $583.32 / $1,024.49 / $6,458.74
| Facility | | $583.32 | $1,024.49 | $6,458.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,457.00 / $9,370.00 / $12,774.00
| Facility | | $5,457.00 | $9,370.00 | $12,774.00 |