- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $490.32 / $5,748.75 / $16,467.00
| Facility | | $490.32 | $5,748.75 | $16,467.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,648.84 / $7,047.08 / $12,042.86
| Facility | | $2,648.84 | $7,047.08 | $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
- $431.29 / $1,742.00 / $9,140.37
| Facility | | $431.29 | $1,742.00 | $9,140.37 |
- 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 |