- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $295.12 / $1,000.00 / $3,890.45
| Facility | | $295.12 | $1,000.00 | $3,890.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,412.54 / $2,344.23 / $6,025.60
| Facility | | $1,412.54 | $2,344.23 | $6,025.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $190.55 / $234.42 / $331.13
| Facility | | $190.55 | $234.42 | $331.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $380.19 / $380.19 / $1,318.26
| Facility | | $380.19 | $380.19 | $1,318.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $524.81 / $1,445.44 / $4,073.80
| Facility | | $524.81 | $1,445.44 | $4,073.80 |