- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $938.40 / $1,198.55 / $8,229.00
| Facility | | $938.40 | $1,198.55 | $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
- $922.40 / $1,266.05 / $1,460.47
| Facility | | $922.40 | $1,266.05 | $1,460.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,108.33 / $1,108.33 / $1,108.33
| Facility | | $1,108.33 | $1,108.33 | $1,108.33 |
- 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 |