- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,026.61 / $1,090.86 / $8,229.00
| Facility | | $1,026.61 | $1,090.86 | $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
- $1,011.54 / $1,388.38 / $1,601.61
| Facility | | $1,011.54 | $1,388.38 | $1,601.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,213.92 / $1,213.92 / $1,213.92
| Facility | | $1,213.92 | $1,213.92 | $1,213.92 |
- 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 |