- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $977.24 / $3,548.13 / $12,022.64
| Facility | | $977.24 | $3,548.13 | $12,022.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,951.21 / $6,165.95 / $11,481.54
| Facility | | $2,951.21 | $6,165.95 | $11,481.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $776.25 / $776.25 / $812.83
| Facility | | $776.25 | $776.25 | $812.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,570.40 / $2,570.40 / $2,570.40
| Facility | | $2,570.40 | $2,570.40 | $2,570.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,748.98 / $45,708.82 / $45,708.82
| Facility | | $11,748.98 | $45,708.82 | $45,708.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $794.33 / $1,174.90 / $4,786.30
| Facility | | $794.33 | $1,174.90 | $4,786.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $776.25 / $1,000.00 / $1,621.81
| Facility | | $776.25 | $1,000.00 | $1,621.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,258.93 / $4,073.80 / $8,709.64
| Facility | | $1,258.93 | $4,073.80 | $8,709.64 |