- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $887.34 / $887.34 / $6,781.00
| Facility | | $887.34 | $887.34 | $6,781.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,088.76 / $4,376.30 / $7,431.64
| Facility | | $2,088.76 | $4,376.30 | $7,431.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,146.67 / $3,045.81 / $7,327.11
| Facility | | $2,146.67 | $3,045.81 | $7,327.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,951.52 / $2,784.60 / $5,769.38
| Facility | | $1,951.52 | $2,784.60 | $5,769.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $859.72 / $1,499.60 / $2,626.59
| Facility | | $859.72 | $1,499.60 | $2,626.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,457.00 / $9,370.00 / $12,774.00
| Facility | | $5,457.00 | $9,370.00 | $12,774.00 |