- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,165.53 / $5,355.00 / $10,817.74
| Facility | | $1,165.53 | $5,355.00 | $10,817.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,152.00 / $2,792.00 / $8,800.00
| Facility | | $1,152.00 | $2,792.00 | $8,800.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $940.26 / $1,152.74 / $1,525.80
| Facility | | $940.26 | $1,152.74 | $1,525.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $879.11 / $1,124.08 / $21,571.00
| Facility | | $879.11 | $1,124.08 | $21,571.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,124.08 / $1,124.08 / $1,253.49
| Facility | | $1,124.08 | $1,124.08 | $1,253.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,233.00 / $4,321.00 / $7,351.00
| Facility | | $2,233.00 | $4,321.00 | $7,351.00 |