- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $485.92 / $2,611.75 / $6,976.00
| Facility | | $485.92 | $2,611.75 | $6,976.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,167.26 / $5,939.08 / $11,503.06
| Facility | | $2,167.26 | $5,939.08 | $11,503.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,186.98 / $1,684.15 / $4,051.46
| Facility | | $1,186.98 | $1,684.15 | $4,051.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,079.07 / $1,539.72 / $3,190.13
| Facility | | $1,079.07 | $1,539.72 | $3,190.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $485.05 / $921.00 / $4,791.18
| Facility | | $485.05 | $921.00 | $4,791.18 |
- 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 |