- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $524.81 / $1,000.00 / $8,317.64
| Facility | | $524.81 | $1,000.00 | $8,317.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,348.96 / $2,137.96 / $2,951.21
| Facility | | $1,348.96 | $2,137.96 | $2,951.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $501.19 / $630.96 / $741.31
| Facility | | $501.19 | $630.96 | $741.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $933.25 / $933.25 / $1,318.26
| Facility | | $933.25 | $933.25 | $1,318.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $602.56 / $1,949.84 / $6,309.57
| Facility | | $602.56 | $1,949.84 | $6,309.57 |