- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,074.02 / $1,137.03 / $8,229.00
| Facility | | $1,074.02 | $1,137.03 | $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
- $1,043.56 / $1,432.33 / $1,652.30
| Facility | | $1,043.56 | $1,432.33 | $1,652.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,267.94 / $1,267.94 / $1,267.94
| Facility | | $1,267.94 | $1,267.94 | $1,267.94 |
- 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 |