- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $422.66 / $1,300.00 / $3,884.00
| Facility | | $422.66 | $1,300.00 | $3,884.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,753.58 / $4,077.94 / $6,046.39
| Facility | | $1,753.58 | $4,077.94 | $6,046.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $293.83 / $2,897.00 / $2,897.00
| Facility | | $293.83 | $2,897.00 | $2,897.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $343.71 / $525.00 / $1,936.96
| Facility | | $343.71 | $525.00 | $1,936.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $470.00 / $1,429.00 / $4,010.00
| Facility | | $470.00 | $1,429.00 | $4,010.00 |