- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $758.58 / $2,511.89 / $7,585.78
| Facility | | $758.58 | $2,511.89 | $7,585.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,548.13 / $6,760.83 / $12,882.50
| Facility | | $3,548.13 | $6,760.83 | $12,882.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $575.44 / $575.44 / $575.44
| Facility | | $575.44 | $575.44 | $575.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,630.78 / $3,630.78 / $3,630.78
| Facility | | $3,630.78 | $3,630.78 | $3,630.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,454.40 / $19,498.45 / $19,498.45
| Facility | | $14,454.40 | $19,498.45 | $19,498.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $616.60 / $1,000.00 / $3,890.45
| Facility | | $616.60 | $1,000.00 | $3,890.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $616.60 / $851.14 / $1,479.11
| Facility | | $616.60 | $851.14 | $1,479.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,630.27 / $8,128.31 / $17,378.01
| Facility | | $2,630.27 | $8,128.31 | $17,378.01 |