- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $691.83 / $4,897.79 / $11,220.18
| Facility | | $691.83 | $4,897.79 | $11,220.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,715.35 / $13,803.84 / $19,054.61
| Facility | | $3,715.35 | $13,803.84 | $19,054.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $416.87 / $467.74 / $524.81
| Facility | | $416.87 | $467.74 | $524.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $512.86 / $724.44 / $1,000.00
| Facility | | $512.86 | $724.44 | $1,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,691.53 / $10,964.78 / $17,378.01
| Facility | | $2,691.53 | $10,964.78 | $17,378.01 |