- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $390.86 / $1,850.00 / $4,392.00
| Facility | | $390.86 | $1,850.00 | $4,392.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,753.58 / $4,539.27 / $6,969.95
| Facility | | $1,753.58 | $4,539.27 | $6,969.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $108.30 / $1,987.13 / $1,987.13
| Facility | | $108.30 | $1,987.13 | $1,987.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $131.31 / $731.00 / $1,936.96
| Facility | | $131.31 | $731.00 | $1,936.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $746.00 / $2,415.00 / $6,661.00
| Facility | | $746.00 | $2,415.00 | $6,661.00 |