- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $741.88 / $4,034.80 / $12,075.00
| Facility | | $741.88 | $4,034.80 | $12,075.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,435.81 / $5,044.83 / $8,656.54
| Facility | | $2,435.81 | $5,044.83 | $8,656.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $843.64 / $1,130.00 / $2,581.96
| Facility | | $843.64 | $1,130.00 | $2,581.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $546.14 / $803.26 / $1,270.93
| Facility | | $546.14 | $803.26 | $1,270.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,550.00 / $10,257.00 / $16,249.00
| Facility | | $1,550.00 | $10,257.00 | $16,249.00 |