- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,004.63 / $1,611.73 / $8,413.00
| Facility | | $1,004.63 | $1,611.73 | $8,413.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,311.30 / $1,311.30 / $1,330.43
| Facility | | $1,311.30 | $1,311.30 | $1,330.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $606.10 / $606.10 / $2,062.80
| Facility | | $606.10 | $606.10 | $2,062.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,004.63 / $1,465.00 / $2,307.04
| Facility | | $1,004.63 | $1,465.00 | $2,307.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $900.00 / $3,733.00 / $6,543.00
| Facility | | $900.00 | $3,733.00 | $6,543.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,703.42 / $6,936.48 / $26,542.00
| Facility | | $5,703.42 | $6,936.48 | $26,542.00 |