- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $674.90 / $3,849.56 / $10,087.00
| Facility | | $674.90 | $3,849.56 | $10,087.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,506.47 / $1,657.11 / $2,812.07
| Facility | | $1,506.47 | $1,657.11 | $2,812.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $778.43 / $3,390.19 / $5,654.79
| Facility | | $778.43 | $3,390.19 | $5,654.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $674.90 / $883.97 / $1,375.00
| Facility | | $674.90 | $883.97 | $1,375.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $773.00 / $1,208.00 / $9,324.00
| Facility | | $773.00 | $1,208.00 | $9,324.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,820.68 / $16,547.20 / $26,542.00
| Facility | | $3,820.68 | $16,547.20 | $26,542.00 |