- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $309.03 / $1,000.00 / $3,890.45
| Facility | | $309.03 | $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
- $257.04 / $323.59 / $416.87
| Facility | | $257.04 | $323.59 | $416.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $467.74 / $478.63 / $1,659.59
| Facility | | $467.74 | $478.63 | $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 |