- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $873.23 / $5,135.00 / $10,817.74
| Facility | | $873.23 | $5,135.00 | $10,817.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,152.00 / $3,025.00 / $8,800.00
| Facility | | $1,152.00 | $3,025.00 | $8,800.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $681.80 / $835.86 / $1,525.80
| Facility | | $681.80 | $835.86 | $1,525.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $634.54 / $1,124.08 / $21,571.00
| Facility | | $634.54 | $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
- $1,981.00 / $4,138.00 / $6,522.00
| Facility | | $1,981.00 | $4,138.00 | $6,522.00 |