- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,041.53 / $3,596.00 / $12,281.00
| Facility | | $1,041.53 | $3,596.00 | $12,281.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,492.38 / $7,275.80 / $14,115.04
| Facility | | $3,492.38 | $7,275.80 | $14,115.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $902.64 / $902.64 / $902.64
| Facility | | $902.64 | $902.64 | $902.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $2,000.00 / $13,960.05
| Facility | | $55.00 | $2,000.00 | $13,960.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,059.24 / $1,414.91 / $2,854.13
| Facility | | $1,059.24 | $1,414.91 | $2,854.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,054.23 / $1,445.43 / $2,854.13
| Facility | | $1,054.23 | $1,445.43 | $2,854.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,154.00 / $3,314.00 / $7,600.00
| Facility | | $1,154.00 | $3,314.00 | $7,600.00 |