- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $218.54 / $943.04 / $2,525.00
| Facility | | $218.54 | $943.04 | $2,525.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,383.51 / $3,031.79 / $6,762.24
| Facility | | $1,383.51 | $3,031.79 | $6,762.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,026.60 / $3,399.36 / $8,177.63
| Facility | | $2,026.60 | $3,399.36 | $8,177.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,748.01 / $2,997.12 / $6,439.08
| Facility | | $1,748.01 | $2,997.12 | $6,439.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $294.80 / $903.58 / $2,767.71
| Facility | | $294.80 | $903.58 | $2,767.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,224.00 / $3,500.00 / $6,275.86
| Facility | | $1,224.00 | $3,500.00 | $6,275.86 |