- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,074.56 / $1,233.16 / $8,229.00
| Facility | | $1,074.56 | $1,233.16 | $8,229.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,049.25 / $9,122.94 / $15,243.15
| Facility | | $5,049.25 | $9,122.94 | $15,243.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,221.01 / $1,675.90 / $1,933.27
| Facility | | $1,221.01 | $1,675.90 | $1,933.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,471.00 / $1,471.00 / $1,471.00
| Facility | | $1,471.00 | $1,471.00 | $1,471.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $405.00 / $2,513.00 / $27,879.00
| Facility | | $405.00 | $2,513.00 | $27,879.00 |