- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $83.18 / $1,000.00 / $3,890.45
| Facility | | $83.18 | $1,000.00 | $3,890.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,801.89 / $10,715.19 / $11,220.18
| Facility | | $3,801.89 | $10,715.19 | $11,220.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $74.13 / $102.33 / $134.90
| Facility | | $74.13 | $102.33 | $134.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $34.67 / $141.25 / $141.25
| Facility | | $34.67 | $141.25 | $141.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $389.05 / $954.99 / $3,388.44
| Facility | | $389.05 | $954.99 | $3,388.44 |