- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $746.32 / $746.32 / $6,575.00
| Facility | | $746.32 | $746.32 | $6,575.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,069.75 / $5,939.08 / $11,966.76
| Facility | | $3,069.75 | $5,939.08 | $11,966.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,802.36 / $2,557.29 / $6,151.90
| Facility | | $1,802.36 | $2,557.29 | $6,151.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,638.51 / $2,337.96 / $4,844.01
| Facility | | $1,638.51 | $2,337.96 | $4,844.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $792.28 / $1,261.28 / $2,523.00
| Facility | | $792.28 | $1,261.28 | $2,523.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,388.00 / $3,500.00 / $6,361.00
| Facility | | $1,388.00 | $3,500.00 | $6,361.00 |