- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,014.04 / $5,135.00 / $10,817.74
| Facility | | $1,014.04 | $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
- $817.66 / $1,002.42 / $2,631.55
| Facility | | $817.66 | $1,002.42 | $2,631.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $764.66 / $1,938.72 / $21,571.00
| Facility | | $764.66 | $1,938.72 | $21,571.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,938.72 / $1,938.72 / $2,161.90
| Facility | | $1,938.72 | $1,938.72 | $2,161.90 |
- 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 |