- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $865.02 / $2,769.52 / $18,711.00
| Facility | | $865.02 | $2,769.52 | $18,711.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,613.81 / $4,554.63 / $11,500.00
| Facility | | $1,613.81 | $4,554.63 | $11,500.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $466.83 / $568.48 / $1,985.59
| Facility | | $466.83 | $568.48 | $1,985.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $662.94 / $1,285.36 / $1,980.00
| Facility | | $662.94 | $1,285.36 | $1,980.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $871.13 / $1,204.66 / $1,300.47
| Facility | | $871.13 | $1,204.66 | $1,300.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $537.44 / $857.53 / $1,613.81
| Facility | | $537.44 | $857.53 | $1,613.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,024.21 / $4,552.03 / $8,712.50
| Facility | | $3,024.21 | $4,552.03 | $8,712.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $702.00 / $1,436.00 / $6,857.00
| Facility | | $702.00 | $1,436.00 | $6,857.00 |