- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $787.00 / $1,011.30 / $6,084.78
| Facility | | $787.00 | $1,011.30 | $6,084.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,241.00 / $9,565.00 / $11,253.00
| Facility | | $8,241.00 | $9,565.00 | $11,253.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $862.46 / $1,242.83 / $1,433.70
| Facility | | $862.46 | $1,242.83 | $1,433.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,085.08 / $1,085.08 / $1,085.08
| Facility | | $1,085.08 | $1,085.08 | $1,085.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $973.00 / $4,639.00 / $12,296.00
| Facility | | $973.00 | $4,639.00 | $12,296.00 |