- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $100.00 / $1,513.56 / $5,495.41
| Facility | | $100.00 | $1,513.56 | $5,495.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,513.56 / $2,398.83 / $4,365.16
| Facility | | $1,513.56 | $2,398.83 | $4,365.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $85.11 / $120.23 / $169.82
| Facility | | $85.11 | $120.23 | $169.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $162.18 / $162.18 / $1,659.59
| Facility | | $162.18 | $162.18 | $1,659.59 |
- 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 |