- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $610.55 / $3,359.25 / $4,828.00
| Facility | | $610.55 | $3,359.25 | $4,828.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,844.35 / $12,197.67 / $25,424.06
| Facility | | $2,844.35 | $12,197.67 | $25,424.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,482.46 / $2,103.40 / $5,060.01
| Facility | | $1,482.46 | $2,103.40 | $5,060.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,347.69 / $1,923.01 / $3,984.26
| Facility | | $1,347.69 | $1,923.01 | $3,984.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $654.33 / $1,065.29 / $5,913.00
| Facility | | $654.33 | $1,065.29 | $5,913.00 |
- 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 |