- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $446.68 / $1,288.25 / $3,715.35
| Facility | | $446.68 | $1,288.25 | $3,715.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $1,949.84 / $3,548.13
| Facility | | $1,000.00 | $1,949.84 | $3,548.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $91.20 / $1,819.70 / $1,819.70
| Facility | | $91.20 | $1,819.70 | $1,819.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $173.78 / $537.03 / $1,258.93
| Facility | | $173.78 | $537.03 | $1,258.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $467.74 / $1,412.54 / $4,168.69
| Facility | | $467.74 | $1,412.54 | $4,168.69 |