- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $446.68 / $5,495.41 / $5,495.41
| Facility | | $446.68 | $5,495.41 | $5,495.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,754.23 / $19,054.61 / $47,863.01
| Facility | | $2,754.23 | $19,054.61 | $47,863.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,481.54 / $18,197.01 / $43,651.58
| Facility | | $11,481.54 | $18,197.01 | $43,651.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,125.38 / $17,378.01 / $34,673.69
| Facility | | $14,125.38 | $17,378.01 | $34,673.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $575.44 / $6,606.93 / $12,302.69
| Facility | | $575.44 | $6,606.93 | $12,302.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,584.89 / $10,000.00 / $26,915.35
| Facility | | $1,584.89 | $10,000.00 | $26,915.35 |