- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $831.76 / $3,162.28 / $8,317.64
| Facility | | $831.76 | $3,162.28 | $8,317.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,344.23 / $4,677.35 / $8,912.51
| Facility | | $2,344.23 | $4,677.35 | $8,912.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $79.43 / $812.83 / $831.76
| Facility | | $79.43 | $812.83 | $831.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,220.18 / $28,840.32 / $28,840.32
| Facility | | $11,220.18 | $28,840.32 | $28,840.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $794.33 / $1,122.02 / $4,466.84
| Facility | | $794.33 | $1,122.02 | $4,466.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $794.33 / $1,000.00 / $1,584.89
| Facility | | $794.33 | $1,000.00 | $1,584.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,698.24 / $5,248.07 / $10,964.78
| Facility | | $1,698.24 | $5,248.07 | $10,964.78 |