- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $235.47 / $1,024.14 / $2,168.00
| Facility | | $235.47 | $1,024.14 | $2,168.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $510.43 / $3,285.55 / $7,238.46
| Facility | | $510.43 | $3,285.55 | $7,238.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,498.16 / $3,542.69 / $8,522.43
| Facility | | $2,498.16 | $3,542.69 | $8,522.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,030.82 / $3,238.87 / $6,710.58
| Facility | | $2,030.82 | $3,238.87 | $6,710.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $404.57 / $1,729.45 / $4,746.00
| Facility | | $404.57 | $1,729.45 | $4,746.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,735.00 / $4,974.00 / $8,812.00
| Facility | | $2,735.00 | $4,974.00 | $8,812.00 |