- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $552.57 / $552.57 / $6,575.00
| Facility | | $552.57 | $552.57 | $6,575.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,138.46 / $5,500.43 / $10,098.06
| Facility | | $3,138.46 | $5,500.43 | $10,098.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,344.25 / $1,906.32 / $4,585.91
| Facility | | $1,344.25 | $1,906.32 | $4,585.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,092.78 / $1,742.83 / $3,610.95
| Facility | | $1,092.78 | $1,742.83 | $3,610.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $511.79 / $965.81 / $7,414.38
| Facility | | $511.79 | $965.81 | $7,414.38 |
- 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 |