- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $524.81 / $2,754.23 / $4,897.79
| Facility | | $524.81 | $2,754.23 | $4,897.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $870.96 / $4,897.79 / $28,840.32
| Facility | | $870.96 | $4,897.79 | $28,840.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $436.52 / $436.52 / $1,000.00
| Facility | | $436.52 | $436.52 | $1,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $354.81 / $776.25 / $7,079.46
| Facility | | $354.81 | $776.25 | $7,079.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,995.26 / $4,265.80 / $9,772.37
| Facility | | $1,995.26 | $4,265.80 | $9,772.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $870.96 / $4,897.79 / $28,840.32
| Facility | | $870.96 | $4,897.79 | $28,840.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,862.09 / $4,265.80 / $9,772.37
| Facility | | $1,862.09 | $4,265.80 | $9,772.37 |