- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $689.29 / $2,384.00 / $10,509.37
| Facility | | $689.29 | $2,384.00 | $10,509.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,051.23 / $9,387.84 / $20,505.30
| Facility | | $3,051.23 | $9,387.84 | $20,505.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,685.37 / $2,390.06 / $5,749.62
| Facility | | $1,685.37 | $2,390.06 | $5,749.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,370.08 / $2,185.09 / $4,527.26
| Facility | | $1,370.08 | $2,185.09 | $4,527.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,016.81 / $2,081.66 / $12,051.00
| Facility | | $1,016.81 | $2,081.66 | $12,051.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,577.00 / $10,743.00 / $12,774.00
| Facility | | $5,577.00 | $10,743.00 | $12,774.00 |