- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $944.45 / $1,206.28 / $8,229.00
| Facility | | $944.45 | $1,206.28 | $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
- $929.52 / $1,275.81 / $1,471.74
| Facility | | $929.52 | $1,275.81 | $1,471.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,118.09 / $1,118.09 / $1,118.09
| Facility | | $1,118.09 | $1,118.09 | $1,118.09 |
- 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 |