- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,511.89 / $3,162.28 / $3,981.07
| Facility | | $2,511.89 | $3,162.28 | $3,981.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $954.99 / $1,000.00 / $1,047.13
| Facility | | $954.99 | $1,000.00 | $1,047.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,309.57 / $6,760.83 / $9,332.54
| Facility | | $6,309.57 | $6,760.83 | $9,332.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $100.00 / $758.58 / $776.25
| Facility | | $100.00 | $758.58 | $776.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $758.58 / $2,187.76 / $2,187.76
| Facility | | $758.58 | $2,187.76 | $2,187.76 |