- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $229.09 / $1,000.00 / $7,413.10
| Facility | | $229.09 | $1,000.00 | $7,413.10 |
- 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
- $131.83 / $190.55 / $229.09
| Facility | | $131.83 | $190.55 | $229.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $257.04 / $257.04 / $1,318.26
| Facility | | $257.04 | $257.04 | $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 |