- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $929.01 / $1,209.64 / $4,828.00
| Facility | | $929.01 | $1,209.64 | $4,828.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,088.76 / $4,221.49 / $7,040.19
| Facility | | $2,088.76 | $4,221.49 | $7,040.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,634.09 / $3,737.39 / $8,990.79
| Facility | | $2,634.09 | $3,737.39 | $8,990.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,394.62 / $3,416.87 / $7,079.36
| Facility | | $2,394.62 | $3,416.87 | $7,079.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $933.83 / $1,629.29 / $2,968.90
| Facility | | $933.83 | $1,629.29 | $2,968.90 |
- 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 |