- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $745.57 / $2,447.00 / $5,150.00
| Facility | | $745.57 | $2,447.00 | $5,150.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,588.66 / $7,750.58 / $11,965.29
| Facility | | $3,588.66 | $7,750.58 | $11,965.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $466.76 / $5,603.53 / $5,603.53
| Facility | | $466.76 | $5,603.53 | $5,603.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $608.17 / $1,026.00 / $4,042.13
| Facility | | $608.17 | $1,026.00 | $4,042.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,100.00 / $4,717.00 / $10,959.00
| Facility | | $1,100.00 | $4,717.00 | $10,959.00 |