- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,020.41 / $1,615.00 / $10,924.00
| Facility | | $1,020.41 | $1,615.00 | $10,924.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $748.70 / $748.70 / $6,025.59
| Facility | | $748.70 | $748.70 | $6,025.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,020.41 / $1,211.00 / $2,020.74
| Facility | | $1,020.41 | $1,211.00 | $2,020.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,248.00 / $9,541.00 / $14,589.00
| Facility | | $2,248.00 | $9,541.00 | $14,589.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,883.96 / $19,913.50 / $26,542.00
| Facility | | $3,883.96 | $19,913.50 | $26,542.00 |