- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $643.04 / $3,195.25 / $4,828.00
| Facility | | $643.04 | $3,195.25 | $4,828.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,961.71 / $12,197.67 / $25,424.06
| Facility | | $2,961.71 | $12,197.67 | $25,424.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,582.64 / $2,245.54 / $5,401.95
| Facility | | $1,582.64 | $2,245.54 | $5,401.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,438.76 / $2,052.96 / $4,253.50
| Facility | | $1,438.76 | $2,052.96 | $4,253.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $643.04 / $1,109.29 / $5,577.00
| Facility | | $643.04 | $1,109.29 | $5,577.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,457.00 / $11,890.00 / $23,633.78
| Facility | | $5,457.00 | $11,890.00 | $23,633.78 |