- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $112.20 / $1,000.00 / $3,890.45
| Facility | | $112.20 | $1,000.00 | $3,890.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,148.15 / $2,137.96 / $2,951.21
| Facility | | $1,148.15 | $2,137.96 | $2,951.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $93.33 / $114.82 / $151.36
| Facility | | $93.33 | $114.82 | $151.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $173.78 / $173.78 / $1,659.59
| Facility | | $173.78 | $173.78 | $1,659.59 |
- 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 |