- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,289.23 / $1,702.32 / $8,229.00
| Facility | | $1,289.23 | $1,702.32 | $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
- $1,578.52 / $2,166.58 / $2,499.32
| Facility | | $1,578.52 | $2,166.58 | $2,499.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,903.52 / $1,903.52 / $1,903.52
| Facility | | $1,903.52 | $1,903.52 | $1,903.52 |
- 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 |