- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $705.88 / $863.82 / $4,828.00
| Facility | | $705.88 | $863.82 | $4,828.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,175.86 / $5,572.33 / $11,146.35
| Facility | | $3,175.86 | $5,572.33 | $11,146.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,183.15 / $3,095.98 / $7,447.79
| Facility | | $2,183.15 | $3,095.98 | $7,447.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,774.74 / $2,830.46 / $5,864.40
| Facility | | $1,774.74 | $2,830.46 | $5,864.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $794.33 / $1,312.37 / $2,643.83
| Facility | | $794.33 | $1,312.37 | $2,643.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,523.00 / $6,275.00 / $9,468.59
| Facility | | $2,523.00 | $6,275.00 | $9,468.59 |