- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,013.00 / $7,521.00 / $9,637.10
| Facility | | $3,013.00 | $7,521.00 | $9,637.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,807.00 / $12,904.00 / $16,138.00
| Facility | | $2,807.00 | $12,904.00 | $16,138.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $998.00 / $4,359.34 / $5,018.95
| Facility | | $998.00 | $4,359.34 | $5,018.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $807.91 / $1,023.56 / $2,255.33
| Facility | | $807.91 | $1,023.56 | $2,255.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,048.00 / $7,771.00 / $11,371.00
| Facility | | $1,048.00 | $7,771.00 | $11,371.00 |