- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $654.73 / $5,135.00 / $10,817.74
| Facility | | $654.73 | $5,135.00 | $10,817.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,145.00 / $2,792.00 / $8,800.00
| Facility | | $1,145.00 | $2,792.00 | $8,800.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $510.42 / $625.76 / $1,525.80
| Facility | | $510.42 | $625.76 | $1,525.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $476.09 / $1,124.08 / $21,571.00
| Facility | | $476.09 | $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
- $1,368.00 / $2,474.00 / $4,951.00
| Facility | | $1,368.00 | $2,474.00 | $4,951.00 |