- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $145.78 / $1,173.68 / $2,525.00
| Facility | | $145.78 | $1,173.68 | $2,525.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $282.66 / $2,669.92 / $6,031.72
| Facility | | $282.66 | $2,669.92 | $6,031.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,669.98 / $3,786.36 / $9,108.60
| Facility | | $2,669.98 | $3,786.36 | $9,108.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,170.50 / $3,461.64 / $7,172.13
| Facility | | $2,170.50 | $3,461.64 | $7,172.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $216.43 / $419.74 / $3,307.00
| Facility | | $216.43 | $419.74 | $3,307.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $976.00 / $2,296.00 / $6,275.00
| Facility | | $976.00 | $2,296.00 | $6,275.00 |