- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $977.24 / $3,090.30 / $8,912.51
| Facility | | $977.24 | $3,090.30 | $8,912.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,548.13 / $5,495.41 / $12,302.69
| Facility | | $3,548.13 | $5,495.41 | $12,302.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $933.25 / $1,288.25 / $1,513.56
| Facility | | $933.25 | $1,288.25 | $1,513.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,174.90 / $1,737.80 / $4,168.69
| Facility | | $1,174.90 | $1,737.80 | $4,168.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $851.14 / $4,677.35 / $10,000.00
| Facility | | $851.14 | $4,677.35 | $10,000.00 |