- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $191.70 / $1,665.94 / $4,828.00
| Facility | | $191.70 | $1,665.94 | $4,828.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $901.39 / $10,766.58 / $24,323.22
| Facility | | $901.39 | $10,766.58 | $24,323.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,752.29 / $5,321.21 / $12,800.89
| Facility | | $3,752.29 | $5,321.21 | $12,800.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,050.34 / $4,864.85 / $10,079.44
| Facility | | $3,050.34 | $4,864.85 | $10,079.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $312.45 / $2,432.96 / $6,927.00
| Facility | | $312.45 | $2,432.96 | $6,927.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,293.00 / $6,652.00 / $9,810.00
| Facility | | $3,293.00 | $6,652.00 | $9,810.00 |