- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,530.80 / $1,648.25 / $8,229.00
| Facility | | $1,530.80 | $1,648.25 | $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
- $1,519.85 / $2,086.07 / $2,406.42
| Facility | | $1,519.85 | $2,086.07 | $2,406.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,831.07 / $1,831.07 / $1,831.07
| Facility | | $1,831.07 | $1,831.07 | $1,831.07 |
- 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 |