- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,980.21 / $2,087.46 / $8,229.00
| Facility | | $1,980.21 | $2,087.46 | $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
- $1,935.65 / $2,656.77 / $3,064.78
| Facility | | $1,935.65 | $2,656.77 | $3,064.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,337.73 / $2,337.73 / $2,337.73
| Facility | | $2,337.73 | $2,337.73 | $2,337.73 |
- 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 |