- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,075.14 / $1,409.98 / $10,647.00
| Facility | | $1,075.14 | $1,409.98 | $10,647.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,496.00 / $10,683.00 / $11,870.00
| Facility | | $9,496.00 | $10,683.00 | $11,870.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $992.81 / $1,368.36 / $1,578.50
| Facility | | $992.81 | $1,368.36 | $1,578.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,204.24 / $1,204.24 / $1,204.24
| Facility | | $1,204.24 | $1,204.24 | $1,204.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,572.00 / $10,917.00 / $31,320.00
| Facility | | $1,572.00 | $10,917.00 | $31,320.00 |