- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $173.78 / $1,000.00 / $8,511.38
| Facility | | $173.78 | $1,000.00 | $8,511.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,258.93 / $2,137.96 / $2,951.21
| Facility | | $1,258.93 | $2,137.96 | $2,951.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $128.82 / $177.83 / $213.80
| Facility | | $128.82 | $177.83 | $213.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $181.97 / $239.88 / $1,318.26
| Facility | | $181.97 | $239.88 | $1,318.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $602.56 / $2,754.23 / $6,309.57
| Facility | | $602.56 | $2,754.23 | $6,309.57 |