- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $370.08 / $2,316.58 / $2,525.00
| Facility | | $370.08 | $2,316.58 | $2,525.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,662.31 / $8,644.58 / $19,529.31
| Facility | | $1,662.31 | $8,644.58 | $19,529.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,566.55 / $7,127.19 / $17,145.43
| Facility | | $4,566.55 | $7,127.19 | $17,145.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,957.31 / $6,283.85 / $13,500.34
| Facility | | $3,957.31 | $6,283.85 | $13,500.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $460.11 / $2,160.77 / $5,668.29
| Facility | | $460.11 | $2,160.77 | $5,668.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,577.00 / $10,743.00 / $12,774.00
| Facility | | $5,577.00 | $10,743.00 | $12,774.00 |