- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,013.32 / $3,877.10 / $10,735.41
| Facility | | $1,013.32 | $3,877.10 | $10,735.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $700.00 / $3,017.91 / $8,410.09
| Facility | | $700.00 | $3,017.91 | $8,410.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $375.00 / $585.00 / $2,472.77
| Facility | | $375.00 | $585.00 | $2,472.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $411.10 / $657.24 / $1,000.00
| Facility | | $411.10 | $657.24 | $1,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $710.00 / $10,069.00 / $16,249.00
| Facility | | $710.00 | $10,069.00 | $16,249.00 |