- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $678.50 / $3,674.31 / $6,575.00
| Facility | | $678.50 | $3,674.31 | $6,575.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,452.86 / $9,951.48 / $20,505.30
| Facility | | $3,452.86 | $9,951.48 | $20,505.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,719.75 / $12,948.87 / $31,150.26
| Facility | | $7,719.75 | $12,948.87 | $31,150.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,658.54 / $11,416.66 / $24,527.76
| Facility | | $6,658.54 | $11,416.66 | $24,527.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $906.58 / $2,208.96 / $10,284.77
| Facility | | $906.58 | $2,208.96 | $10,284.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,437.00 / $10,743.00 / $15,245.28
| Facility | | $3,437.00 | $10,743.00 | $15,245.28 |