- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $204.17 / $1,023.29 / $1,023.29
| Facility | | $204.17 | $1,023.29 | $1,023.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,754.23 / $4,786.30 / $9,332.54
| Facility | | $2,754.23 | $4,786.30 | $9,332.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,630.27 / $3,801.89 / $9,120.11
| Facility | | $2,630.27 | $3,801.89 | $9,120.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,951.21 / $3,630.78 / $7,079.46
| Facility | | $2,951.21 | $3,630.78 | $7,079.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $288.40 / $1,479.11 / $6,760.83
| Facility | | $288.40 | $1,479.11 | $6,760.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,884.03 / $5,248.07 / $8,912.51
| Facility | | $2,884.03 | $5,248.07 | $8,912.51 |