- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $323.59 / $1,000.00 / $3,715.35
| Facility | | $323.59 | $1,000.00 | $3,715.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,348.96 / $2,137.96 / $2,951.21
| Facility | | $1,348.96 | $2,137.96 | $2,951.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $177.83 / $245.47 / $316.23
| Facility | | $177.83 | $245.47 | $316.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $302.00 / $331.13 / $1,318.26
| Facility | | $302.00 | $331.13 | $1,318.26 |
- 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 |