- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,755.40 / $1,847.27 / $8,229.00
| Facility | | $1,755.40 | $1,847.27 | $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
- $1,712.93 / $2,351.08 / $2,712.14
| Facility | | $1,712.93 | $2,351.08 | $2,712.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,065.51 / $2,065.51 / $2,065.51
| Facility | | $2,065.51 | $2,065.51 | $2,065.51 |
- 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 |