- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $872.00 / $3,188.00 / $11,453.00
| Facility | | $872.00 | $3,188.00 | $11,453.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,130.38 / $3,680.36 / $7,337.28
| Facility | | $2,130.38 | $3,680.36 | $7,337.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $813.15 / $813.15 / $831.05
| Facility | | $813.15 | $813.15 | $831.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,512.62 / $2,006.70 / $2,530.00
| Facility | | $1,512.62 | $2,006.70 | $2,530.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,929.30 / $11,500.00 / $26,542.00
| Facility | | $7,929.30 | $11,500.00 | $26,542.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $875.55 / $1,082.07 / $2,015.47
| Facility | | $875.55 | $1,082.07 | $2,015.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $880.43 / $1,089.79 / $2,066.94
| Facility | | $880.43 | $1,089.79 | $2,066.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,634.00 / $4,166.00 / $10,600.00
| Facility | | $1,634.00 | $4,166.00 | $10,600.00 |