- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $489.78 / $3,467.37 / $7,943.28
| Facility | | $489.78 | $3,467.37 | $7,943.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $575.44 / $1,000.00 / $1,202.26
| Facility | | $575.44 | $1,000.00 | $1,202.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $331.13 / $331.13 / $331.13
| Facility | | $331.13 | $331.13 | $331.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $199.53 / $316.23 / $3,801.89
| Facility | | $199.53 | $316.23 | $3,801.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,023.29 / $1,288.25 / $3,311.31
| Facility | | $1,023.29 | $1,288.25 | $3,311.31 |