- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,183.11 / $7,521.00 / $9,637.10
| Facility | | $3,183.11 | $7,521.00 | $9,637.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $816.76 / $7,483.00 / $10,956.00
| Facility | | $816.76 | $7,483.00 | $10,956.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $998.00 / $3,113.54 / $3,584.65
| Facility | | $998.00 | $3,113.54 | $3,584.65 |
- 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
- $833.00 / $6,639.00 / $9,973.00
| Facility | | $833.00 | $6,639.00 | $9,973.00 |