- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $818.26 / $1,045.09 / $8,229.00
| Facility | | $818.26 | $1,045.09 | $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
- $796.50 / $1,093.23 / $1,261.13
| Facility | | $796.50 | $1,093.23 | $1,261.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $965.65 / $965.65 / $965.65
| Facility | | $965.65 | $965.65 | $965.65 |
- 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 |