- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $237.05 / $1,235.21 / $2,525.00
| Facility | | $237.05 | $1,235.21 | $2,525.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,211.86 / $3,310.52 / $6,762.24
| Facility | | $1,211.86 | $3,310.52 | $6,762.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,608.38 / $4,375.22 / $10,525.17
| Facility | | $2,608.38 | $4,375.22 | $10,525.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,249.81 / $3,857.51 / $8,287.54
| Facility | | $2,249.81 | $3,857.51 | $8,287.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $307.12 / $1,139.51 / $3,439.97
| Facility | | $307.12 | $1,139.51 | $3,439.97 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,224.00 / $3,500.00 / $6,361.00
| Facility | | $1,224.00 | $3,500.00 | $6,361.00 |