- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $598.00 / $2,023.00 / $4,913.78
| Facility | | $598.00 | $2,023.00 | $4,913.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,726.83 / $4,886.39 / $7,665.79
| Facility | | $1,726.83 | $4,886.39 | $7,665.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $323.42 / $2,663.50 / $2,663.50
| Facility | | $323.42 | $2,663.50 | $2,663.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $422.68 / $525.00 / $2,425.00
| Facility | | $422.68 | $525.00 | $2,425.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $464.00 / $1,429.00 / $4,010.00
| Facility | | $464.00 | $1,429.00 | $4,010.00 |