- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $498.77 / $3,228.20 / $16,467.00
| Facility | | $498.77 | $3,228.20 | $16,467.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,685.64 / $7,109.73 / $12,042.86
| Facility | | $2,685.64 | $7,109.73 | $12,042.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,829.28 / $3,829.28 / $4,920.68
| Facility | | $3,829.28 | $3,829.28 | $4,920.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $425.09 / $1,354.68 / $2,594.00
| Facility | | $425.09 | $1,354.68 | $2,594.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,028.00 / $19,627.00 / $25,620.00
| Facility | | $3,028.00 | $19,627.00 | $25,620.00 |