- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $202.80 / $1,029.75 / $2,168.00
| Facility | | $202.80 | $1,029.75 | $2,168.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,627.56 / $4,152.50 / $7,238.46
| Facility | | $2,627.56 | $4,152.50 | $7,238.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,544.48 / $3,608.39 / $8,680.46
| Facility | | $2,544.48 | $3,608.39 | $8,680.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,068.48 / $3,298.93 / $6,835.01
| Facility | | $2,068.48 | $3,298.93 | $6,835.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $342.73 / $1,676.75 / $4,746.00
| Facility | | $342.73 | $1,676.75 | $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 |