- 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
- $1,258.93 / $2,137.96 / $2,951.21
| Facility | | $1,258.93 | $2,137.96 | $2,951.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $380.19 / $524.81 / $676.08
| Facility | | $380.19 | $524.81 | $676.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $588.84 / $707.95 / $1,318.26
| Facility | | $588.84 | $707.95 | $1,318.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $524.81 / $1,445.44 / $5,248.07
| Facility | | $524.81 | $1,445.44 | $5,248.07 |