- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $863.64 / $2,149.46 / $9,144.08
| Facility | | $863.64 | $2,149.46 | $9,144.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,945.00 / $6,090.00 / $19,582.00
| Facility | | $1,945.00 | $6,090.00 | $19,582.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $928.52 / $1,336.26 / $1,541.47
| Facility | | $928.52 | $1,336.26 | $1,541.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,150.28 / $1,171.73 / $12,571.00
| Facility | | $1,150.28 | $1,171.73 | $12,571.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $973.00 / $4,639.00 / $12,296.00
| Facility | | $973.00 | $4,639.00 | $12,296.00 |