- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,148.83 / $2,601.92 / $11,124.00
| Facility | | $1,148.83 | $2,601.92 | $11,124.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $515.00 / $5,030.53 / $9,490.07
| Facility | | $515.00 | $5,030.53 | $9,490.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,104.78 / $1,579.19 / $1,953.01
| Facility | | $1,104.78 | $1,579.19 | $1,953.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,746.00 / $6,492.00 / $18,665.00
| Facility | | $1,746.00 | $6,492.00 | $18,665.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $7,639.45 / $27,770.10
| Facility | | $55.00 | $7,639.45 | $27,770.10 |