- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $338.58 / $1,272.08 / $2,525.00
| Facility | | $338.58 | $1,272.08 | $2,525.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,732.84 / $5,898.73 / $12,294.94
| Facility | | $1,732.84 | $5,898.73 | $12,294.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,692.40 / $4,516.16 / $10,864.23
| Facility | | $2,692.40 | $4,516.16 | $10,864.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,322.29 / $3,981.77 / $8,554.51
| Facility | | $2,322.29 | $3,981.77 | $8,554.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $435.07 / $1,264.61 / $3,674.37
| Facility | | $435.07 | $1,264.61 | $3,674.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,100.00 / $6,652.00 / $10,618.00
| Facility | | $2,100.00 | $6,652.00 | $10,618.00 |