- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,316.89 / $1,384.86 / $8,229.00
| Facility | | $1,316.89 | $1,384.86 | $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
- $1,284.14 / $1,762.54 / $2,033.23
| Facility | | $1,284.14 | $1,762.54 | $2,033.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,549.57 / $1,549.57 / $1,549.57
| Facility | | $1,549.57 | $1,549.57 | $1,549.57 |
- 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 |