- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $426.58 / $3,890.45 / $14,454.40
| Facility | | $426.58 | $3,890.45 | $14,454.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,311.31 / $19,952.62 / $47,863.01
| Facility | | $3,311.31 | $19,952.62 | $47,863.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,772.37 / $14,125.38 / $33,884.42
| Facility | | $9,772.37 | $14,125.38 | $33,884.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,964.78 / $13,489.63 / $26,302.68
| Facility | | $10,964.78 | $13,489.63 | $26,302.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $660.69 / $5,754.40 / $13,489.63
| Facility | | $660.69 | $5,754.40 | $13,489.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,897.79 / $10,000.00 / $26,915.35
| Facility | | $4,897.79 | $10,000.00 | $26,915.35 |