- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $112.20 / $1,862.09 / $5,623.41
| Facility | | $112.20 | $1,862.09 | $5,623.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,187.76 / $8,317.64 / $10,471.29
| Facility | | $2,187.76 | $8,317.64 | $10,471.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $100.00 / $102.33 / $117.49
| Facility | | $100.00 | $102.33 | $117.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $173.78 / $173.78 / $1,148.15
| Facility | | $173.78 | $173.78 | $1,148.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,412.54 / $3,715.35 / $6,456.54
| Facility | | $1,412.54 | $3,715.35 | $6,456.54 |