- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $214.76 / $3,813.82 / $4,828.00
| Facility | | $214.76 | $3,813.82 | $4,828.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,121.44 / $9,076.59 / $20,505.30
| Facility | | $1,121.44 | $9,076.59 | $20,505.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,588.95 / $13,405.14 / $32,247.89
| Facility | | $8,588.95 | $13,405.14 | $32,247.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,893.17 / $11,818.94 / $25,392.04
| Facility | | $6,893.17 | $11,818.94 | $25,392.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $297.08 / $3,458.41 / $10,386.14
| Facility | | $297.08 | $3,458.41 | $10,386.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,437.00 / $9,370.00 / $12,774.00
| Facility | | $3,437.00 | $9,370.00 | $12,774.00 |