- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $204.17 / $1,995.26 / $7,244.36
| Facility | | $204.17 | $1,995.26 | $7,244.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,344.23 / $8,317.64 / $10,471.29
| Facility | | $2,344.23 | $8,317.64 | $10,471.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $173.78 / $181.97 / $204.17
| Facility | | $173.78 | $181.97 | $204.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $199.53 / $446.68 / $1,000.00
| Facility | | $199.53 | $446.68 | $1,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,698.24 / $3,715.35 / $6,456.54
| Facility | | $1,698.24 | $3,715.35 | $6,456.54 |