- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,538.00 / $5,297.00 / $8,031.00
| Facility | | $2,538.00 | $5,297.00 | $8,031.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $816.76 / $2,807.00 / $10,956.00
| Facility | | $816.76 | $2,807.00 | $10,956.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $992.64 / $1,409.72 / $1,623.02
| Facility | | $992.64 | $1,409.72 | $1,623.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $735.56 / $886.65 / $1,552.85
| Facility | | $735.56 | $886.65 | $1,552.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $911.00 / $4,939.00 / $8,879.00
| Facility | | $911.00 | $4,939.00 | $8,879.00 |