- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $416.87 / $3,981.07 / $8,317.64
| Facility | | $416.87 | $3,981.07 | $8,317.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,011.87 / $6,165.95 / $57,543.99
| Facility | | $5,011.87 | $6,165.95 | $57,543.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $691.83 / $691.83 / $1,000.00
| Facility | | $691.83 | $691.83 | $1,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $588.84 / $3,630.78 / $7,762.47
| Facility | | $588.84 | $3,630.78 | $7,762.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $346.74 / $346.74 / $478.63
| Facility | | $346.74 | $346.74 | $478.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $67.61 / $257.04 / $812.83
| Facility | | $67.61 | $257.04 | $812.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $144.54 / $645.65 / $4,265.80
| Facility | | $144.54 | $645.65 | $4,265.80 |