- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $779.51 / $779.51 / $7,859.00
| Facility | | $779.51 | $779.51 | $7,859.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,178.08 / $3,144.69 / $6,646.29
| Facility | | $1,178.08 | $3,144.69 | $6,646.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,828.30 / $2,853.51 / $6,864.49
| Facility | | $1,828.30 | $2,853.51 | $6,864.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,584.38 / $2,604.01 / $5,405.11
| Facility | | $1,584.38 | $2,604.01 | $5,405.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $801.86 / $1,414.26 / $2,484.03
| Facility | | $801.86 | $1,414.26 | $2,484.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $796.00 / $3,500.00 / $8,152.00
| Facility | | $796.00 | $3,500.00 | $8,152.00 |