- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $394.18 / $5,780.59 / $13,335.00
| Facility | | $394.18 | $5,780.59 | $13,335.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,685.64 / $7,097.80 / $12,042.86
| Facility | | $2,685.64 | $7,097.80 | $12,042.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,021.41 / $2,021.41 / $2,597.55
| Facility | | $2,021.41 | $2,021.41 | $2,597.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $345.44 / $1,130.04 / $2,001.97
| Facility | | $345.44 | $1,130.04 | $2,001.97 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,316.61 / $12,456.00 / $19,665.00
| Facility | | $2,316.61 | $12,456.00 | $19,665.00 |