- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,012.78 / $1,124.33 / $8,229.00
| Facility | | $1,012.78 | $1,124.33 | $8,229.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,923.72 / $7,537.12 / $11,845.28
| Facility | | $3,923.72 | $7,537.12 | $11,845.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $988.26 / $1,356.43 / $1,564.75
| Facility | | $988.26 | $1,356.43 | $1,564.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,190.89 / $1,190.89 / $1,190.89
| Facility | | $1,190.89 | $1,190.89 | $1,190.89 |
- 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 |