- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $242.02 / $1,165.48 / $2,525.00
| Facility | | $242.02 | $1,165.48 | $2,525.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,261.61 / $5,843.70 / $12,294.94
| Facility | | $1,261.61 | $5,843.70 | $12,294.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,646.41 / $4,130.35 / $9,936.12
| Facility | | $2,646.41 | $4,130.35 | $9,936.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,123.90 / $3,641.62 / $7,823.73
| Facility | | $2,123.90 | $3,641.62 | $7,823.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $311.69 / $1,151.77 / $3,323.33
| Facility | | $311.69 | $1,151.77 | $3,323.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,100.00 / $5,499.00 / $9,810.00
| Facility | | $2,100.00 | $5,499.00 | $9,810.00 |