- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $751.98 / $751.98 / $6,575.00
| Facility | | $751.98 | $751.98 | $6,575.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,028.61 / $5,357.75 / $10,376.78
| Facility | | $3,028.61 | $5,357.75 | $10,376.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,753.53 / $2,488.01 / $5,985.24
| Facility | | $1,753.53 | $2,488.01 | $5,985.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,426.23 / $2,274.64 / $4,712.79
| Facility | | $1,426.23 | $2,274.64 | $4,712.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $768.42 / $1,309.01 / $5,499.18
| Facility | | $768.42 | $1,309.01 | $5,499.18 |
- 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 |