- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $323.59 / $1,000.00 / $8,511.38
| Facility | | $323.59 | $1,000.00 | $8,511.38 |
- 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
- $165.96 / $204.17 / $288.40
| Facility | | $165.96 | $204.17 | $288.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $331.13 / $331.13 / $1,318.26
| Facility | | $331.13 | $331.13 | $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 |