- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $870.27 / $1,132.05 / $10,152.00
| Facility | | $870.27 | $1,132.05 | $10,152.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,212.00 / $9,015.00 / $11,253.00
| Facility | | $7,212.00 | $9,015.00 | $11,253.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $943.48 / $1,290.10 / $1,488.23
| Facility | | $943.48 | $1,290.10 | $1,488.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,051.45 / $1,138.32 / $1,138.32
| Facility | | $1,051.45 | $1,138.32 | $1,138.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $739.00 / $3,828.00 / $8,582.00
| Facility | | $739.00 | $3,828.00 | $8,582.00 |