- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,609.42 / $6,805.10 / $9,479.00
| Facility | | $2,609.42 | $6,805.10 | $9,479.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $880.09 / $5,118.00 / $12,904.00
| Facility | | $880.09 | $5,118.00 | $12,904.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $998.00 / $4,177.78 / $4,809.92
| Facility | | $998.00 | $4,177.78 | $4,809.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,023.56 / $2,143.32 / $2,255.33
| Facility | | $1,023.56 | $2,143.32 | $2,255.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $833.00 / $6,639.00 / $9,973.00
| Facility | | $833.00 | $6,639.00 | $9,973.00 |