- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $229.09 / $1,000.00 / $3,890.45
| Facility | | $229.09 | $1,000.00 | $3,890.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,258.93 / $2,137.96 / $2,951.21
| Facility | | $1,258.93 | $2,137.96 | $2,951.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $194.98 / $269.15 / $346.74
| Facility | | $194.98 | $269.15 | $346.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $371.54 / $371.54 / $1,318.26
| Facility | | $371.54 | $371.54 | $1,318.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $602.56 / $2,754.23 / $6,309.57
| Facility | | $602.56 | $2,754.23 | $6,309.57 |