- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $760.67 / $3,649.91 / $6,575.00
| Facility | | $760.67 | $3,649.91 | $6,575.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,088.76 / $5,167.10 / $11,688.59
| Facility | | $2,088.76 | $5,167.10 | $11,688.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,852.87 / $2,628.95 / $6,324.30
| Facility | | $1,852.87 | $2,628.95 | $6,324.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,684.43 / $2,403.48 / $4,979.76
| Facility | | $1,684.43 | $2,403.48 | $4,979.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $829.56 / $1,305.79 / $3,312.00
| Facility | | $829.56 | $1,305.79 | $3,312.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,412.00 / $4,746.00 / $8,812.00
| Facility | | $2,412.00 | $4,746.00 | $8,812.00 |