- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $467.74 / $2,818.38 / $4,897.79
| Facility | | $467.74 | $2,818.38 | $4,897.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $870.96 / $4,677.35 / $28,840.32
| Facility | | $870.96 | $4,677.35 | $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
- $588.84 / $645.65 / $6,456.54
| Facility | | $588.84 | $645.65 | $6,456.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $338.84 / $724.44 / $7,079.46
| Facility | | $338.84 | $724.44 | $7,079.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $524.81 / $3,801.89 / $9,772.37
| Facility | | $524.81 | $3,801.89 | $9,772.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $870.96 / $4,677.35 / $28,840.32
| Facility | | $870.96 | $4,677.35 | $28,840.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,071.52 / $3,890.45 / $11,220.18
| Facility | | $1,071.52 | $3,890.45 | $11,220.18 |