- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,046.59 / $5,201.00 / $11,627.00
| Facility | | $1,046.59 | $5,201.00 | $11,627.00 |
- 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
- $845.18 / $1,036.16 / $1,525.80
| Facility | | $845.18 | $1,036.16 | $1,525.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $786.06 / $1,124.08 / $21,571.00
| Facility | | $786.06 | $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 / $4,072.00 / $6,522.00
| Facility | | $1,981.00 | $4,072.00 | $6,522.00 |