- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $138.04 / $1,000.00 / $3,890.45
| Facility | | $138.04 | $1,000.00 | $3,890.45 |
- 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
- $89.13 / $117.49 / $154.88
| Facility | | $89.13 | $117.49 | $154.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $177.83 / $177.83 / $1,318.26
| Facility | | $177.83 | $177.83 | $1,318.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $524.81 / $1,348.96 / $5,248.07
| Facility | | $524.81 | $1,348.96 | $5,248.07 |