- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $895.52 / $1,387.30 / $11,093.00
| Facility | | $895.52 | $1,387.30 | $11,093.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,140.00 / $5,958.00 / $9,462.00
| Facility | | $2,140.00 | $5,958.00 | $9,462.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $820.89 / $1,067.16 / $1,231.33
| Facility | | $820.89 | $1,067.16 | $1,231.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $761.00 / $1,037.58 / $1,873.52
| Facility | | $761.00 | $1,037.58 | $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 |