- 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
- $880.09 / $9,678.00 / $12,904.00
| Facility | | $880.09 | $9,678.00 | $12,904.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,020.00 / $3,753.19 / $4,321.08
| Facility | | $1,020.00 | $3,753.19 | $4,321.08 |
- 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
- $1,048.00 / $7,771.00 / $11,371.00
| Facility | | $1,048.00 | $7,771.00 | $11,371.00 |