- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $148.37 / $2,168.00 / $2,316.84
| Facility | | $148.37 | $2,168.00 | $2,316.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,533.65 / $2,631.94 / $5,194.88
| Facility | | $1,533.65 | $2,631.94 | $5,194.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,297.41 / $8,267.87 / $19,889.50
| Facility | | $5,297.41 | $8,267.87 | $19,889.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,251.49 / $7,289.56 / $15,661.03
| Facility | | $4,251.49 | $7,289.56 | $15,661.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $193.90 / $1,675.33 / $5,842.95
| Facility | | $193.90 | $1,675.33 | $5,842.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,224.00 / $3,500.00 / $6,361.00
| Facility | | $1,224.00 | $3,500.00 | $6,361.00 |