- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $416.87 / $1,000.00 / $3,890.45
| Facility | | $416.87 | $1,000.00 | $3,890.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,380.38 / $2,137.96 / $2,951.21
| Facility | | $1,380.38 | $2,137.96 | $2,951.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $363.08 / $524.81 / $691.83
| Facility | | $363.08 | $524.81 | $691.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $512.86 / $794.33 / $1,318.26
| Facility | | $512.86 | $794.33 | $1,318.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $50.12 / $602.56 / $3,162.28
| Facility | | $50.12 | $602.56 | $3,162.28 |