- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $831.76 / $5,011.87 / $12,302.69
| Facility | | $831.76 | $5,011.87 | $12,302.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,754.23 / $6,165.95 / $12,589.25
| Facility | | $2,754.23 | $6,165.95 | $12,589.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,137.96 / $3,019.95 / $7,244.36
| Facility | | $2,137.96 | $3,019.95 | $7,244.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,344.23 / $2,951.21 / $5,754.40
| Facility | | $2,344.23 | $2,951.21 | $5,754.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $870.96 / $1,621.81 / $6,918.31
| Facility | | $870.96 | $1,621.81 | $6,918.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,090.30 / $5,495.41 / $10,000.00
| Facility | | $3,090.30 | $5,495.41 | $10,000.00 |