- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $606.30 / $4,799.45 / $11,269.00
| Facility | | $606.30 | $4,799.45 | $11,269.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,866.79 / $6,804.97 / $11,730.39
| Facility | | $1,866.79 | $6,804.97 | $11,730.39 |
- 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
- $221.92 / $342.84 / $508.59
| Facility | | $221.92 | $342.84 | $508.59 |
- 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 |