- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,080.13 / $5,135.00 / $10,817.74
| Facility | | $1,080.13 | $5,135.00 | $10,817.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,760.00 / $3,967.00 / $14,996.00
| Facility | | $1,760.00 | $3,967.00 | $14,996.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $860.89 / $1,055.42 / $1,994.14
| Facility | | $860.89 | $1,055.42 | $1,994.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $822.07 / $1,469.12 / $21,571.00
| Facility | | $822.07 | $1,469.12 | $21,571.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,469.12 / $1,469.12 / $1,638.24
| Facility | | $1,469.12 | $1,469.12 | $1,638.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,840.00 / $5,625.00 / $9,245.00
| Facility | | $2,840.00 | $5,625.00 | $9,245.00 |