- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $961.02 / $3,682.00 / $12,941.00
| Facility | | $961.02 | $3,682.00 | $12,941.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,122.95 / $7,372.81 / $14,745.61
| Facility | | $4,122.95 | $7,372.81 | $14,745.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $923.50 / $6,540.10 / $6,540.10
| Facility | | $923.50 | $6,540.10 | $6,540.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,178.82 / $1,178.82 / $1,178.82
| Facility | | $1,178.82 | $1,178.82 | $1,178.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,812.26 / $16,547.20 / $26,542.00
| Facility | | $5,812.26 | $16,547.20 | $26,542.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,024.10 / $1,337.43 / $2,295.21
| Facility | | $1,024.10 | $1,337.43 | $2,295.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,024.10 / $1,350.62 / $2,451.67
| Facility | | $1,024.10 | $1,350.62 | $2,451.67 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,093.00 / $6,000.00 / $13,134.00
| Facility | | $2,093.00 | $6,000.00 | $13,134.00 |