- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $710.09 / $1,024.30 / $4,828.00
| Facility | | $710.09 | $1,024.30 | $4,828.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,357.80 / $12,197.67 / $25,424.06
| Facility | | $3,357.80 | $12,197.67 | $25,424.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,742.59 / $2,472.48 / $5,947.89
| Facility | | $1,742.59 | $2,472.48 | $5,947.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,584.17 / $2,260.44 / $4,683.38
| Facility | | $1,584.17 | $2,260.44 | $4,683.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $721.26 / $1,214.34 / $5,913.00
| Facility | | $721.26 | $1,214.34 | $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 |