- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $691.83 / $2,137.96 / $7,244.36
| Facility | | $691.83 | $2,137.96 | $7,244.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,818.38 / $18,197.01 / $26,302.68
| Facility | | $2,818.38 | $18,197.01 | $26,302.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $602.56 / $630.96 / $707.95
| Facility | | $602.56 | $630.96 | $707.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $660.69 / $1,000.00 / $1,548.82
| Facility | | $660.69 | $1,000.00 | $1,548.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,388.44 / $6,025.60 / $10,715.19
| Facility | | $3,388.44 | $6,025.60 | $10,715.19 |