- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $870.96 / $3,630.78 / $12,022.64
| Facility | | $870.96 | $3,630.78 | $12,022.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,691.53 / $5,011.87 / $9,772.37
| Facility | | $2,691.53 | $5,011.87 | $9,772.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $630.96 / $630.96 / $660.69
| Facility | | $630.96 | $630.96 | $660.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,949.84 / $1,949.84 / $1,949.84
| Facility | | $1,949.84 | $1,949.84 | $1,949.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,912.51 / $45,708.82 / $45,708.82
| Facility | | $8,912.51 | $45,708.82 | $45,708.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $676.08 / $1,000.00 / $5,128.61
| Facility | | $676.08 | $1,000.00 | $5,128.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $660.69 / $812.83 / $1,348.96
| Facility | | $660.69 | $812.83 | $1,348.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,698.24 / $5,128.61 / $10,964.78
| Facility | | $1,698.24 | $5,128.61 | $10,964.78 |