- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,864.38 / $2,114.26 / $8,229.00
| Facility | | $1,864.38 | $2,114.26 | $8,229.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,429.20 / $10,940.32 / $14,964.00
| Facility | | $5,429.20 | $10,940.32 | $14,964.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,828.50 / $2,509.71 / $2,895.13
| Facility | | $1,828.50 | $2,509.71 | $2,895.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,207.21 / $2,207.21 / $2,207.21
| Facility | | $2,207.21 | $2,207.21 | $2,207.21 |
- 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 |