- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,039.11 / $1,098.93 / $8,229.00
| Facility | | $1,039.11 | $1,098.93 | $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
- $1,019.02 / $1,398.64 / $1,613.44
| Facility | | $1,019.02 | $1,398.64 | $1,613.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,226.75 / $1,226.75 / $1,226.75
| Facility | | $1,226.75 | $1,226.75 | $1,226.75 |
- 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 |