- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $911.82 / $1,386.00 / $7,212.00
| Facility | | $911.82 | $1,386.00 | $7,212.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $946.40 / $5,757.57 / $8,240.00
| Facility | | $946.40 | $5,757.57 | $8,240.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $858.92 / $1,094.70 / $1,263.11
| Facility | | $858.92 | $1,094.70 | $1,263.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $761.00 / $1,061.77 / $1,873.52
| Facility | | $761.00 | $1,061.77 | $1,873.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,298.30 / $6,741.00 / $11,284.00
| Facility | | $2,298.30 | $6,741.00 | $11,284.00 |